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Gender differences in patients with acute ST-elevation myocardial infarction complicated by cardiogenic shock

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Abstract

Introduction

The aim of our analysis is to assess gender differences in baseline characteristics, acute therapies, and clinical outcome in patients with acute ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock.

Methods

The Maximal Individual Therapy of Acute Myocardial Infarction PLUS registry (MITRA PLUS) is a German prospective, multicenter, observational data pool of current treatment of STEMI.

Results

STEMI was more often (P < 0.0001) complicated by cardiogenic shock in female patients (12.9%) when compared to male patients (9.3%). This was still true after adjusting for confounding variables (OR 1.19, 95% CI 1.09–1.30). Women with STEMI admitted in a cardiogenic shock were older (P < 0.0001) and had more often concomitant diseases (P < 0.0001). There was no differences in rates of reperfusion therapy (OR 0.92, 95% CI 0.77–1.09). Hospital mortality was 67.7% in female patients, when compared to 57.2% in male patients (P < 0.0001). After adjusting for confounding variables in the multivariate analysis hospital mortality did not differ between men and women (OR 1.16, 95% CI 0.98–1.38). Early reperfusion therapy was associated with a significant reduction of hospital mortality in female patients with STEMI complicated by cardiogenic shock (OR 0.68, 95% CI 0.52–0.90) with primary PCI being more effective than thrombolytic therapy (OR 0.46, 95% CI 0.31–0.68).

Conclusion

In women, STEMI was more often complicated by cardiogenic shock when compared to men. However, the use of early reperfusion therapy did not differ between the sexes. Primary PCI was associated with the best outcome in female patients with STEMI complicated by cardiogenic shock and is therefore the therapy of choice.

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References

  1. Lerner DJ, Kannel WB (1986) Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population. Am Heart J 111:383–390

    Article  CAS  PubMed  Google Scholar 

  2. Wingard DL, Cohn BA, Kaplan GA, Cirillo PM, Cohen RD (1989) Sex differentials in morbidity and mortality risks examined by age and cause in the same cohort. Am J Epidemiol 130:601–610

    CAS  PubMed  Google Scholar 

  3. Vaccarino V, Krumholz HM, Berkman LF, Horwitz RI (1995) Sex differences in mortality after myocardial infarction: is there evidence for an increased risk for women? Circulation 91(6):1861–1871

    CAS  PubMed  Google Scholar 

  4. Greenland P, Reicher-Reiss H, Goldbourtthe U, Israeli SPRINT Investigators, Behar S (1991) In-hospital and 1-year mortality in 1524 women after myocardial infarction. Circulation 83(2):484–491

    CAS  PubMed  Google Scholar 

  5. Fiebach HN, Viscoli CM, Horwitz RI (1990) Differences between women and men in survival after myocardial infarction: biology or methodology? JAMA 263:1092–1096

    Article  CAS  PubMed  Google Scholar 

  6. Gottlieb S, Moss AJ, McDermott M, Eberly S (1994) Comparison of posthospital survival after cute myocardial infarction in women, men. Am J Cardiol 74(7):727–730

    Article  CAS  PubMed  Google Scholar 

  7. Karlson BW, Herlitz J, Hartford M (1996) Prognosis in myocardial infarction in relation to gender. Cardiology 87(3):230–234

    Article  CAS  PubMed  Google Scholar 

  8. Maynard C, Althouse R, Cerquiera M, Olsufka M, Kennedy JW (2001) Underutilization of thrombolytic therapy in eligible women with acute myocardial infarction. Am J Cardiol 142(4):604–610

    Google Scholar 

  9. Heer T, Schiele R, Schneider S, Gitt AK, Wienbergen H, Gottwik M, Gieseler U, Voigtländer T, Hauptmann KE, Wagner S, Senges J (2002) Gender differences in acute myocardial infarction in the era of reperfusion (the MITRA registry). Am J Cardiol 89(5):511–517

    Article  PubMed  Google Scholar 

  10. Ayanian JZ, Epstein AM (1991) Differences in the use of procedures between women and men hospitalized for coronary heart disease. N Engl J Med 325:221–225

    Article  CAS  PubMed  Google Scholar 

  11. Steingart RM, Packer M, Hamm P et al (1991) Sex differences in the management of coronary artery disease. N Engl J Med 325:226–230

    CAS  PubMed  Google Scholar 

  12. Gottlieb S, Harpaz D, Shotan A, Boyko V, Leor J, Cohen M, Mandelzweig L, Mazouz B, Stern S, Behar S (2000) Sex differences in management and outcome after acute myocardial infarction in the 1990s: a prospective observational community-based study. Circulation 102(20): 2484–2490

    CAS  PubMed  Google Scholar 

  13. Pagley PR, Yarzebski J, Goldberg R et al (1993) Gender differences in the treatment of patients with acute myocardial infarction. Arch Intern Med 153:625–629

    Article  CAS  PubMed  Google Scholar 

  14. Krumholz HM, Douglas PS, Lauer MS et al (1992) Selection of patients for coronary angiography and coronary revascularization early after myocardial infarction: is there evidence for gender bias? Ann Intern Med 116:785–790

    CAS  PubMed  Google Scholar 

  15. Goldberg RJ, Gore JM, Alpert JS et al (1991) Cardiogenic shock after acute myocardial infarction—incidence and mortality from a community wide perspective 1975–1988. N Engl J Med 325:1117–1122

    CAS  PubMed  Google Scholar 

  16. Holmes DR Jr, Bates ER, Kleiman NS et al (1995) Contemporary reperfusion therapy for cardiogenic shock: the GUSTO-I trial experience. J Am Coll Cardiol 26:668–674

    Article  PubMed  Google Scholar 

  17. Hasdai D, Topol EJ, Califf RM et al (2000) Cardiogenic shock complicating acute coronary syndromes. Lancet 356(9231):749–756

    Article  CAS  PubMed  Google Scholar 

  18. Bauer T, Hoffmann R, Jünger C, Koeth O, Zahn R, Gitt A, Heer T, Bestehorn K, Senges J, Zeymer U (2009) Efficacy of a 24-h primary percutaneous coronary intervention service on outcome in patients with ST elevation myocardial infarction in clinical practice. Clin Res Cardiol 98(3):171–178

    Article  PubMed  Google Scholar 

  19. Koeth O, Bauer T, Wienbergen H, Gitt AK, Juenger C, Zeymer U, Hauptmann KE, Glunz HG, Sechtem U, Senges J, Zahn R, Maximal Individual Therapy in Acute Myocardial Infarction Plus (MITRA Plus) Study Group (2009) Angioplasty within 24 h after thrombolysis in patients with acute ST-elevation myocardial infarction: current use, predictors and outcome. Results of the MITRA plus registry. Clin Res Cardiol 98(2):107–113

    Article  CAS  PubMed  Google Scholar 

  20. Meneveau N, Séronde MF, Descotes-Genon V, Dutheil J, Chopard R, Ecarnot F, Briand F, Bernard Y, Schiele F, Bassand JP (2009) Immediate versus delayed angioplasty in infarct-related arteries with TIMI III flow and ST segment recovery: a matched comparison in acute myocardial infarction patients. Clin Res Cardiol 98(4):257–264

    Article  PubMed  Google Scholar 

  21. Van de Werf F, Ardissino D, Betriu A, Cokkinos DV, Falk E, Fox KA, Julian D, Lengyel M, Neumann FJ, Ruzyllo W, Thygesen C, Underwood SR, Vahanian A, Verheugt FW, Wijns W, Task force on the management of acute myocardial infarction of the European Society of Cardiology (2003) Management of acute myocardial infarction in patients presenting with ST-segment elevation. The task force on the management of acute myocardial infarction of the European Society of Cardiology. Eur Heart J 24(1):28–66

    Article  PubMed  Google Scholar 

  22. Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, Hochman JS, Krumholz HM, Lamas GA, Mullany CJ, Pearle DL, Sloan MA, Smith SC Jr, 2004 Writing Committee Members, Anbe DT, Kushner FG, Ornato JP, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Halperin JL, Hunt SA, Lytle BW, Nishimura R, Page RL, Riegel B, Tarkington LG, Yancy CW (2008) 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee. Circulation 117(2):296–329

    Article  PubMed  Google Scholar 

  23. Rustige J, Schiele R, Burczyk U, Koch A, Gottwik M, Neuhauss KL, Tebbe U, Uebis R, Senges J (1997) The 60 minutes Myocardial Infarction Project. Treatment and clinical outcome of patients with acute myocardial infarction in Germany. Eur Heart J 18:1438–1446

    CAS  PubMed  Google Scholar 

  24. Schuster S, Koch A, Burczyk U, Schiele R, Glunz HG, Voigtlander T, Limbourg P, Stuby K, Berg G, Gieseler U, Jakob M, Hauptmann P, Senges J (1999) Use of coronary angiography after acute myocardial infarction in Germany: a comparison of daily clinical practice with international guidelines. MITRA Study. Z Kardiol 88(10):795–801

    Article  CAS  PubMed  Google Scholar 

  25. Wagner S, Schneider S, Schiele R, Fischer F, Dehn H, Grube R, Becker G, Baumgartel B, Altmann E, Senges J (1999) Acute myocardial infarction in Germany between 1996 and 1998: therapy and intrahospital course. Results of the Myocardial Infarction Registry (MIR) in Germany. Kardiol 88(10):857–867

    Article  CAS  Google Scholar 

  26. Zeymer U, Gitt AK, Jünger C, Heer T, Wienbergen H, Koeth O, Bauer T, Mark B, Zahn R, Gottwik M, Senges J, Acute COronary Syndromes (ACOS) registry investigators (2006) Effect of clopidogrel on 1-year mortality in hospital survivors of acute ST-segment elevation myocardial infarction in clinical practice. Eur Heart J 27(22):2661–2666

    Article  CAS  PubMed  Google Scholar 

  27. Holmes DR Jr, Berger PB, Hochman JS et al (1999) Cardiogenic shock in patients with acute ischemic syndromes with and without ST-segment elevation. Circulation 100:2067–2073

    PubMed  Google Scholar 

  28. Hasdai D, Holmes DR Jr, Topol EJ et al (1999) Frequency and clinical outcome of cardiogenic shock during acute myocardial infarction among patients receiving reteplase or alteplase: results from GUSTO III. Eur Heart J 20:128–135

    Article  CAS  PubMed  Google Scholar 

  29. Oka RK, Fortmann SP, Varady AN (1996) Differences in treatment of acute myocardial infarction by sex, age, and other factors (the Stanford Five-City Project). Am J Cardiol 78:861–865

    Article  CAS  PubMed  Google Scholar 

  30. Funk M, Griffey KA (1995) Relation of gender to the use of cardiac procedures in acute myocardial infarction. Am J Cardiol 76:226–229

    Article  Google Scholar 

  31. Kostis JB, Wilson AC, O’Dowd K (1994) Sex differences in the management and long-term outcome of acute myocardial infarction—a statewide study. Circulation 90:1715–1730

    CAS  PubMed  Google Scholar 

  32. Wong CC, Froelicher ES, Bacchetti P, Barron HV, Gee L, Selby JV, Lundstrom R, Swain B, Truman A (1997) Influence of gender on cardiovascular mortality in acute myocardial infarction patients with high indication for coronary angiography. Circulation 96(Suppl II):II-51–II-57

    Google Scholar 

  33. Berger PB, Holmes DR Jr, Stebbins AL, Bates ER, Califf RM, Topol EJ (1997) Impact of an aggressive invasive catheterization and revascularization strategy on mortality in patients with cardiogenic shock in the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) Trial: an observational study. Circulation 96:122–127 View Record in Scopus|Cited By in Scopus (136)

    CAS  PubMed  Google Scholar 

  34. Berger PB, Tuttle RH, Holmes DR Jr et al (1999) One-year survival among patients with acute myocardial infarction complicated by cardiogenic shock, and its relation to early revascularization: results from the GUSTO-I trial. Circulation 99:873–878

    CAS  PubMed  Google Scholar 

  35. Webb JG, Sanborn TA, Sleeper LA, Carere RG, Buller CE, Slater JN, Baran KW, Koller PT, Talley JD, Porway M, Hochman JS, SHOCK Investigators (2001) Percutaneous coronary intervention for cardiogenic shock in the SHOCK Trial Registry. Am Heart J 141(6):964–970

    Article  CAS  PubMed  Google Scholar 

  36. Lee KL, Woodlief LH, Topol EJ, Weaver D, Betrin A, Col J, Simoons M, Aylward P, Van der Werfthe F, GUSTO-I Investigators, Califf RM (1995) Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction. Circulation 91:1659–1668

    CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Cardiology, Herzzentrum Ludwigshafen, Ludwigshafen, Germany

    Oliver Koeth, Ralf Zahn, Tobias Heer, Timm Bauer, Bärbel Klein, Anselm Kai Gitt & Uwe Zeymer

  2. Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, Germany

    Claus Juenger, Anselm Kai Gitt, Jochen Senges & Uwe Zeymer

  3. Department of Cardiology, Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen, Germany

    Uwe Zeymer

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  1. Oliver Koeth
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  2. Ralf Zahn
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  3. Tobias Heer
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Correspondence to Uwe Zeymer.

Additional information

This study is conducted for the Maximal Individual Therapy In Acute Myocardial Infarction Plus (MITRA Plus) Study group.

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Koeth, O., Zahn, R., Heer, T. et al. Gender differences in patients with acute ST-elevation myocardial infarction complicated by cardiogenic shock. Clin Res Cardiol 98, 781–786 (2009). https://doi.org/10.1007/s00392-009-0080-7

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  • DOI: https://doi.org/10.1007/s00392-009-0080-7

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