Sex Differences in Characteristics, Resource Utilization, and Outcomes of Cardiogenic Shock: Data From the Critical Care Cardiology Trials Network (CCCTN) Registry.

Autor:	Daniels LB; Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla (L.B.D., N.P.)., Phreaner N; Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla (L.B.D., N.P.)., Berg DD; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (D.D.B., E.A.B., J.-G.P., D.A.M.)., Bohula EA; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (D.D.B., E.A.B., J.-G.P., D.A.M.)., Chaudhry SP; Department of Medicine, St Vincent Heart Center, Indianapolis, IN (S.-P.C.)., Fordyce CB; Division of Cardiology, The University of British Columbia, Vancouver, Canada (C.B.F.)., Goldfarb MJ; Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (M.J.G.)., Katz JN; Division of Cardiology, New York University Grossman School of Medicine and Bellevue Hospital, New York, NY (J.N.K.)., Kenigsberg BB; Departments of Cardiology and Critical Care, MedStar Washington Hospital Center, DC (B.B.K., A.I.P.)., Lawler PR; Division of Cardiology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada (P.R.L.)., Martillo Correa MA; Division of Cardiology, University of Miami, FL (M.A.M.C.)., Papolos AI; Departments of Cardiology and Critical Care, MedStar Washington Hospital Center, DC (B.B.K., A.I.P.)., Roswell RO; Northwell, Departments of Cardiology and Science Education, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY (R.O.R.)., Sinha SS; Division of Cardiology, Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, VA (S.S.S.)., van Diepen S; Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (S.V.D.)., Park JG; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (D.D.B., E.A.B., J.-G.P., D.A.M.)., Morrow DA; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (D.D.B., E.A.B., J.-G.P., D.A.M.).
Jazyk:	angličtina
Zdroj:	Circulation. Cardiovascular quality and outcomes [Circ Cardiovasc Qual Outcomes] 2024 Aug; Vol. 17 (8), pp. e010614. Date of Electronic Publication: 2024 Jun 20.
DOI:	10.1161/CIRCOUTCOMES.123.010614
Abstrakt:	Background: Sex disparities exist in the management and outcomes of various cardiovascular diseases. However, little is known about sex differences in cardiogenic shock (CS). We sought to assess sex-related differences in the characteristics, resource utilization, and outcomes of patients with CS. Methods: The Critical Care Cardiology Trials Network is a multicenter registry of advanced cardiac intensive care units (CICUs) in North America. Between 2018 and 2022, each center (N=35) contributed annual 2-month snapshots of consecutive CICU admissions. Patients with CS were stratified as either CS after acute myocardial infarction or heart failure-related CS (HF-CS). Multivariable logistic regression was used for analyses. Results: Of the 22 869 admissions in the overall population, 4505 (20%) had CS. Among 3923 patients with CS due to ventricular failure (32% female), 1235 (31%) had CS after acute myocardial infarction and 2688 (69%) had HF-CS. Median sequential organ failure assessment scores did not differ by sex. Women with HF-CS had shorter CICU lengths of stay (4.5 versus 5.4 days; P <0.0001) and shorter overall lengths of hospital stay (10.9 versus 12.8 days; P <0.0001) than men. Women with HF-CS were less likely to receive pulmonary artery catheters (50% versus 55%; P <0.01) and mechanical circulatory support (26% versus 34%; P <0.0001) compared with men. Women with HF-CS had higher in-hospital mortality than men, even after adjusting for age, illness severity, and comorbidities (34% versus 23%; odds ratio, 1.76 [95% CI, 1.42-2.17]). In contrast, there were no significant sex differences in utilization of advanced CICU monitoring and interventions, or mortality, among patients with CS after acute myocardial infarction. Conclusions: Women with HF-CS had lower use of pulmonary artery catheters and mechanical circulatory support, shorter CICU lengths of stay, and higher in-hospital mortality than men, even after accounting for age, illness severity, and comorbidities. These data highlight the need to identify underlying reasons driving the differences in treatment decisions, so outcomes gaps in HF-CS can be understood and eliminated. Competing Interests: Drs Berg, Bohula, Park, and Morrow are members of the TIMI Study Group, which has received institutional research grant support through Brigham and Women’s Hospital from Abbott, Abiomed, Amgen, Anthos Therapeutics, ARCA Biopharma, Inc, AstraZeneca, Bayer HealthCare Pharmaceuticals, Inc, Daiichi-Sankyo, Eisai, Intarcia, Ionis Pharmaceuticals, Inc, Janssen Research and Development, LLC, MedImmune, Merck, Novartis, Pfizer, Quark Pharmaceuticals, Regeneron Pharmaceuticals, Inc, Roche, Siemens Healthcare Diagnostics, Inc, Softcell Medical Ltd, The Medicines Company, and Zora Biosciences. Dr Katz reports modest research funding from Abbott Corporation. The other authors report no conflicts.
Databáze:	MEDLINE
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