Central Illustration
Sex disparities in cardiogenic shock: Risk factors, treatment intensity, and mortality in Latin America. Women presented higher mortality but had less treatment intensity among SCAI C or higher stages. Also, in the circles, we looked at similar (cross-over areas) and different (blue = men and red = women) risk factors for mortality.
Figure 1
Patient flow diagram. Flow of patient screening, exclusions, and final cohorts with propensity score matching. AMI-CS, acute myocardial infarction–related cardiogenic shock; CS, cardiogenic shock; PSM, propensity score matching; CSWG-SCAI, cardiogenic shock working group-society for cardiovascular angiography and interventions.
Table 1
Demographics, clinical parameters, management, and outcomes of patients with AMI and non-AMI cardiogenic shock, stratified by sex.
| AMI-CS | NON-AMI-CS | ||||||
|---|---|---|---|---|---|---|---|
| MEN (n = 4025) | WOMEN (n = 991) | P-VALUE | MEN (n = 2432) | WOMEN (n = 1982) | P-VALUE | ||
| Age (years) | 60 (52–68) | 67 (59–75) | <0.001 | 60 (46–71) | 63 (50–75) | <0.001 | |
| Body mass index (kg/m2) | 27.1 (24.8–29.69) | 26.67 (23.88–29.64) | <0.001 | 25.71 (23.44–28.36) | 25.33 (22.36–29.14) | 0.012 | |
| Smoking history (%) | 2708 (67.3) | 320 (33.3) | <0.001 | 1289 (53) | 320 (16.1) | <0.001 | |
| Dyslipidemia (%) | 1201 (29.8) | 298 (30.1) | 0.886 | 490 (20.1) | 253 (12.8) | <0.001 | |
| Hypertension (%) | 1975 (49.1) | 701 (70.7) | <0.001 | 1039 (42.7) | 964 (48.6) | <0.001 | |
| COPD (%) | 76 (1.9) | 33 (3.3) | 0.005 | 135 (5.6) | 201 (10.1) | <0.001 | |
| Heart failure history (%) | 349 (8.7) | 107 (10.8) | 0.037 | 1295 (53.2) | 826 (41.7) | <0.001 | |
| Chronic kidney disease (%) | 239 (5.9) | 91 (9.2) | <0.001 | 408 (16.8) | 251 (12.7) | <0.001 | |
| Diabetes mellitus (%) | 1652 (41) | 581 (58.6) | <0.001 | 600 (24.7) | 511 (25.8) | 0.398 | |
| Previous MI (%) | 910 (22.6) | 183 (18.5) | 0.005 | 499 (20.5) | 145 (7.3) | <0.001 | |
| Previous PCI (%) | 498 (12.4) | 79 (8) | <0.001 | 245 (10.1) | 62 (3.1) | <0.001 | |
| Previous CABG (%) | 102 (2.5) | 34 (3.4) | <0.001 | 116 (4.8) | 35 (1.8) | <0.001 | |
| Stroke history (%) | 102 (2.5) | 25 (2.5) | 0.984 | 133 (5.5) | 173 (8.7) | <0.001 | |
| Previous atrial fibrillation (%) | 76 (1.9) | 38 (3.8) | <0.001 | 445 (18.3) | 650 (32.8) | <0.001 | |
| Type of ACS (%) | NSTEMI | 1086 (27) | 381 (38.4) | <0.001 | (–) | (–) | NA |
| STEMI | 2939 (73) | 610 (61.6) | (–) | (–) | |||
| Admission vital signs and paraclinical work-up | |||||||
| Systolic blood pressure (mmHg) | 123 (110–140) | 121 (100–146) | 0.082 | 110 (90–130) | 110 (90–130) | 0.498 | |
| Diastolic blood pressure (mmHg) | 77 (68–90) | 72 (60–85) | <0.001 | 66 (60–80) | 65 (59–80) | 0.249 | |
| Medium arterial pressure (mmHg) | 92.67 (81–106.67) | 90 (74–104.33) | <0.001 | 80.67 (70–93.33) | 80 (70–94.67) | 0.917 | |
| Heart rate (bpm) | 80 (70–98) | 80 (68–98) | 0.283 | 90 (70–110) | 90 (65–110) | 0.785 | |
| Respiratory rate (rpm) | 18 (16–20) | 18 (18–22) | <0.001 | 20 (18–24) | 20 (18–24) | 0.778 | |
| LVEF (%) | 45 (35–54) | 46 (35–55) | <0.001 | 40 (25–57) | 54 (40–60) | <0.001 | |
| Hemoglobin (g/dL) | 15.4 (14–16.6) | 13 (11.5–14.3) | <0.001 | 14 (12–15.7) | 12.6 (10.6–14.3) | <0.001 | |
| Leukocytes (c*109 L) | 11.6 (9.07–14.6) | 11 (8.7–13.9) | <0.001 | 9.8 (7.5–13) | 9.5 (6.9–13.4) | 0.016 | |
| Neutrophils (%) | 78.4 (70–85) | 77.7 (68.15–84) | 0.045 | 78 (69.7–85) | 79 (69.4–86) | 0.112 | |
| Platelets (c*109 L) | 222 (183–267) | 252.5 (203–302) | <0.001 | 188 (143–244) | 197 (142–263) | 0.001 | |
| Glucose (mg/dL) | 160 (124.9–234) | 180 (131–269) | <0.001 | 120 (99–157) | 126 (101–169) | <0.001 | |
| BUN (mg/dL) | 19 (14.4–28) | 22 (16–34) | <0.001 | 31 (20–53) | 29 (18–49.39) | <0.001 | |
| Creatinine (mg/dL) | 1.1 (0.9–1.45) | 1 (0.79–1.5) | <0.001 | 1.46 (1.09–2.25) | 1.2 (0.86–1.98) | <0.001 | |
| eGFR (mL/min/1.73 m2) | 73.09 (49.88–91.79) | 57.46 (34.73–82.44) | <0.001 | 51.75 (29.54–78.8) | 48.21 (25.26–75.78) | 0.001 | |
| Chloride (mEq/L) | 103 (100–105.6) | 102 (98.01–105) | <0.001 | 101 (96.7–105) | 101 (96–105) | 0.324 | |
| Sodium (mEq/L) | 137 (134–139) | 136 (133–139) | <0.001 | 135 (131–138.3) | 135 (131–138.1) | 0.164 | |
| Potassium (mEq/L) | 4.2 (3.9–4.64) | 4.3 (3.9–4.7) | 0.164 | 4.44 (4–5.1) | 4.4 (3.92–5.1) | 0.05 | |
| Albumin (g/dL) | 3.72 (3.4–4.03) | 3.56 (3.19–3.87) | <0.001 | 3.4 (2.97–3.8) | 3.4 (3–3.79) | 0.301 | |
| AST (UI/L) | 85 (36–243) | 64 (30–192.61) | <0.001 | 37 (23–84.5) | 34.9 (23–60.5) | 0.002 | |
| ALT (UI/L) | 51.4 (31–94.6) | 41 (22.9–84.06) | <0.001 | 32 (19–74.4) | 27 (17–52.6) | <0.001 | |
| Lactate dehydrogenase (UI/L) | 484.95 (260–942) | 432 (250–812) | 0.002 | 340 (210.5–574.5) | 340.5 (217.3–584) | 0.279 | |
| C-reactive protein (mg/L) | 13.5 (4.2–59.8) | 14.6 (4.9–61.7) | 0.216 | 28.7 (9.1–86.85) | 22.74 (7.3–71.1) | <0.001 | |
| 72h – minimum pH | 7.4 (7.35–7.44) | 7.38 (7.33–7.43) | <0.001 | 7.39 (7.32–7.44) | 7.38 (7.31–7.43) | 0.003 | |
| 72h – maximum lactate | 2.4 (2–3.3) | 2.3 (2–3.5) | 0.122 | 2.4 (2–3.6) | 2.4 (1.9–3.6) | 0.43 | |
| Cardiogenic shock management | |||||||
| Primary reperfusion (%) | NR* | 2553 (63.4) | 717 (72.4) | <0.001 | (–) | (–) | NA |
| pPCI | 1077 (26.8) | 205 (20.7) | (–) | (–) | |||
| PI | 395 (9.80) | 69 (7.00) | (–) | (–) | |||
| PAC (%) | 283 (7.00) | 66 (6.70) | 0.681 | 64 (2.6) | 25 (1.3) | 0.001 | |
| Mechanical ventilation (%) | 667 (16.6) | 186 (18.8) | 0.099 | 482 (19.8) | 417 (21) | 0.317 | |
| Hemodialysis (%) | 140 (3.50) | 52 (5.20) | 0.009 | 157 (6.50) | 119 (6) | 0.538 | |
| Number of vasoactives | 0 | 2744 (68.2) | 603 (60.8) | <0.001 | 1390 (57.2) | 1158 (58.4) | 0.136 |
| 1 | 489 (12.1) | 157 (15.8) | 498 (20.5) | 417 (21) | |||
| 2 | 362 (9.00) | 113 (11.4) | 349 (14.4) | 283 (14.3) | |||
| 3 | 333 (8.30) | 88 (8.90) | 162 (6.7) | 110 (5.5) | |||
| 4 | 97 (2.40) | 30 (3.00) | 33 (1.40) | 14 (0.7) | |||
| Levosimendan (%) | 224 (5.60) | 47 (4.70) | 0.305 | 149 (6.1) | 51 (2.6) | <0.001 | |
| Dobutamine (%) | 819 (20.3) | 228 (23.0) | 0.065 | 548 (22.5) | 312 (15.7) | <0.001 | |
| Norepinephrine (%) | 1060 (26.3) | 337 (34.0) | <0.001 | 782 (32.2) | 694 (35.0) | 0.045 | |
| Vasopressin (%) | 497 (12.3) | 155 (15.6) | 0.006 | 335 (13.8) | 312 (15.7) | 0.066 | |
| MCS (%) | 594 (14.8) | 115 (11.6) | 0.011 | 50 (2.1) | 27 (1.4) | 0.08 | |
| Cardiogenic shock outcomes | |||||||
| SCAI (%) | E | 567 (14.1) | 174 (17.6) | <0.001 | 433 (17.8) | 371 (18.7) | 0.296 |
| D | 392 (9.70) | 112 (11.3) | 312 (12.8) | 218 (11.0) | |||
| C | 573 (14.2) | 172 (17.4) | 522 (21.5) | 428 (21.6) | |||
| B | 2493 (61.9) | 533 (53.8) | 1165 (47.9) | 965 (48.7) | |||
| Mortality (%) | 656 (16.3) | 244 (24.6) | <0.001 | 586 (24.1) | 536 (27) | 0.025 | |
| Stroke (%) | 46 (1.1) | 20 (2) | 0.03 | 31 (1.3) | 29 (1.5) | 0.591 | |
| VT/VF (%) | 538 (13.4) | 128 (12.9) | 0.708 | 237 (9.7) | 180 (9.1) | 0.454 | |
| GIB (%) | 93 (2.3) | 30 (3) | 0.191 | 49 (2) | 45 (2.3) | 0.558 | |
| PE (%) | 0 | 1 (0.1) | 0.198 | 8 (0.3) | 7 (0.4) | 0.891 | |
| AKI (%) | 881 (21.9) | 307 (31) | <0.001 | 866 (35.6) | 784 (39.6) | 0.007 | |
| Nosocomial pneumonia (%) | 179 (4.4) | 42 (4.2) | 0.774 | 82 (3.4) | 74 (3.7) | 0.517 | |
| Sepsis (%) | 160 (4) | 41 (4.1) | 0.816 | 192 (7.9) | 154 (7.8) | 0.878 | |
[i] *NR patients comprise NSTEMI patients or STEMI late presenters that did not have a primary reperfusion.
ACS, acute coronary syndrome; AMI, acute myocardial infarction; AKI, acute kidney injury; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BUN, blood urea nitrogen; CABG, coronary artery bypass grafting; COPD, chronic obstructive pulmonary disease; CRP, C-reactive protein; CS, cardiogenic shock; eGFR, estimated glomerular filtration rate; GIB, gastrointestinal bleeding; LVEF, left ventricular ejection fraction; MCS, mechanical circulatory support; NSTEMI, non-ST segment elevation myocardial infarction; NR, not primary reperfused; PCI, percutaneous coronary intervention; pPCI, primary PCI; PE, pulmonary embolism; PAC, pulmonary artery catheterization; PI, pharmacoinvasive strategy; SCAI, Society for Cardiovascular Angiography and Interventions; STEMI, ST segment elevation myocardial infarction; VF, ventricular fibrillation; VT, ventricular tachycardia.
Table 2
Demographics, clinical parameters, management, and outcomes of patients with AMI cardiogenic shock, stratified by sex and survival.
| MEN IN AMI-CS | WOMEN IN AMI-CS | ||||||
|---|---|---|---|---|---|---|---|
| SURVIVORS (n = 3369) | NON-SURVIVORS (n = 656) | P-VALUE | SURVIVORS (n = 747) | NON-SURVIVORS (n = 244) | P-VALUE | ||
| Age (years) | 59 (52–67) | 65 (57–73) | <0.001 | 66 (57–74) | 70 (63–78) | <0.001 | |
| Body mass index (kg/m2) | 27.31 (24.84–29.76) | 26.57 (24.22–28.72) | <0.001 | 26.89 (23.98–29.9) | 25.96 (23.79–29.3) | 0.11 | |
| Smoking history (%) | 2275 (67.5) | 433 (66) | 0.447 | 251 (33.6) | 69 (28.3) | 0.123 | |
| Dyslipidemia (%) | 1009 (29.9) | 192 (29.3) | 0.727 | 232 (31.1) | 66 (27) | 0.236 | |
| Hypertension (%) | 1619 (48.1) | 356 (54.3) | 0.004 | 525 (70.3) | 176 (72.1) | 0.581 | |
| COPD (%) | 50 (1.5) | 26 (4) | <0.001 | 24 (3.2) | 9 (3.7) | 0.719 | |
| Heart failure history (%) | 263 (7.8) | 86 (13.1) | <0.001 | 72 (9.2) | 35 (14.3) | 0.04 | |
| Chronic kidney disease (%) | 155 (4.6) | 84 (12.8) | <0.001 | 66 (8.8) | 25 (10.2) | 0.508 | |
| Diabetes mellitus (%) | 1301 (38.6) | 351 (53.3) | <0.001 | 412 (55.2) | 169 (69.3) | <0.001 | |
| Previous MI (%) | 746 (22.1) | 164 (25) | 0.11 | 145 (19.4) | 38 (15.6) | 0.18 | |
| Previous PCI (%) | 428 (12.7) | 70 (10.7) | 0.148 | 70 (9.4) | 9 (3.7) | 0.004 | |
| Previous CABG (%) | 85 (2.5) | 17 (2.6) | 0.919 | 26 (3.5) | 8 (3.3) | 0.88 | |
| Stroke history (%) | 76 (2.3) | 26 (4) | 0.011 | 17 (2.3) | 8 (3.3) | 0.386 | |
| Previous atrial fibrillation (%) | 61 (1.8) | 15 (2.3) | 0.413 | 24 (3.2) | 14 (5.7) | 0.075 | |
| Type of ACS (%) | NSTEMI | 930 (27.6) | 156 (23.8) | 0.044 | 304 (40.7) | 77 (31.6) | 0.011 |
| STEMI | 2439 (72.4) | 500 (76.2) | 443 (59.3) | 167 (68.4) | |||
| Admission vital signs and paraclinical work-up | |||||||
| Systolic blood pressure (mmHg) | 128 (110–145) | 110 (90–124) | <0.001 | 128 (110–150) | 107 (90–126) | <0.001 | |
| Diastolic blood pressure (mmHg) | 80 (70–90) | 70 (59–80) | <0.001 | 75 (64–90) | 65 (51–79) | <0.001 | |
| Medium arterial pressure (mmHg) | 94 (83.33–106.67) | 80.5 (68.83–93.33) | <0.001 | 93.33 (80–106.67) | 78.83 (66.33–93.33) | <0.001 | |
| Heart rate (bpm) | 80 (70–95) | 90 (72–109) | <0.001 | 80 (68–95) | 88 (67–100) | 0.016 | |
| Respiratory rate (rpm) | 18 (16–20) | 20 (18–24) | <0.001 | 18 (17–21) | 20 (18–24) | <0.001 | |
| LVEF (%) | 47 (37–55) | 30 (24–40) | <0.001 | 50 (40–57) | 35 (28–45) | <0.001 | |
| Hemoglobin (g/dL) | 15.5 (14.1–16.7) | 14.4 (12.85–16) | <0.001 | 13.2 (11.6–14.5) | 12.6 (11.3–14) | 0.003 | |
| Leukocytes (c*109 L) | 11.37 (8.97–14.16) | 12.9 (9.8–16.7) | <0.001 | 10.8 (8.42–13.6) | 11.8 (9.3–14.6) | 0.001 | |
| Neutrophils (%) | 77.9 (69–84.1) | 82 (75–87) | <0.001 | 77 (67–84) | 80 (72.3–85) | 0.001 | |
| Platelets (c*109 L) | 224 (187–267) | 212 (164–267) | <0.001 | 255 (209–309) | 242 (173–292) | <0.001 | |
| Glucose (mg/dL) | 156 (123–225) | 192 (135–288.5) | <0.001 | 178.5 (130–259) | 186 (134–287) | 0.175 | |
| BUN (mg/dL) | 18 (14–25) | 29 (20–46) | <0.001 | 21 (15–30) | 29.5 (20.8–43) | <0.001 | |
| Creatinine (mg/dL) | 1.06 (0.9–1.3) | 1.6 (1.2–2.4) | <0.001 | 0.9 (0.7–1.36) | 1.3 (0.97–2) | <0.001 | |
| eGFR (mL/min/1.73 m2) | 76.99 (57.67–93.73) | 44.26 (26.34–66.86) | <0.001 | 63.64 (39.67–88.07) | 41.48 (25.25–61.64) | <0.001 | |
| Chloride (mEq/L) | 103 (100–105) | 103 (99.55–106) | 0.734 | 102 (99–105) | 101 (97.9–105) | 0.073 | |
| Sodium (mEq/L) | 137 (134–139) | 136 (134–139) | 0.171 | 136 (133.75–139) | 136 (132–139) | 0.145 | |
| Potassium (mEq/L) | 4.2 (3.9–4.6) | 4.5 (4–5) | <0.001 | 4.2 (3.9–4.6) | 4.49 (4–5) | <0.001 | |
| Albumin (g/dL) | 3.8 (3.44–4.07) | 3.37 (3–3.72) | <0.001 | 3.6 (3.29–3.9) | 3.3 (3–3.7) | <0.001 | |
| AST (UI/L) | 76.45 (34–209) | 190.5 (56.85–509) | <0.001 | 53.6 (28.65–149) | 133 (48.5–323) | <0.001 | |
| ALT (UI/L) | 48.9 (30–86) | 80 (41.9–186.7) | <0.001 | 37 (21.3–71) | 61.8 (31–158) | <0.001 | |
| Lactate dehydrogenase (UI/L) | 451.5 (250–848.5) | 846 (396–1643) | <0.001 | 381 (231.5–695.5) | 645.5 (399–1117) | <0.001 | |
| C-reactive protein (mg/L) | 11.8 (3.7–50) | 51.7 (12.66–144) | <0.001 | 12.3 (4.5–46.5) | 38 (9.8–120) | <0.001 | |
| 72h – minimum pH | 7.4 (7.36–7.44) | 7.31 (7.21–7.38) | <0.001 | 7.4 (7.36–7.43) | 7.32 (7.21–7.4) | <0.001 | |
| 72h – maximum lactate | 2.4 (2–3.1) | 3.25 (2–6.26) | <0.001 | 2.3 (2–3.1) | 3.2 (1.9–6.75) | <0.001 | |
| Cardiogenic shock management | |||||||
| Primary reperfusion (%) | NR* | 2054 (61) | 499 (76.1) | <0.001 | 523 (70) | 194 (79.5) | 0.014 |
| pPCI | 958 (28.4) | 119 (18.1) | 166 (22.2) | 39 (16.0) | |||
| PI | 357 (10.6) | 38 (5.8) | 58 (7.8) | 11 (4.50) | |||
| PAC (%) | 140 (4.2) | 143 (21.8) | <0.001 | 36 (4.8) | 30 (12.3) | <0.001 | |
| Mechanical ventilation (%) | 253 (7.5) | 414 (63.1) | <0.001 | 61 (8.2) | 125 (51.2) | <0.001 | |
| Hemodialysis (%) | 54 (1.6) | 86 (13.1) | <0.001 | 24 (3.2) | 28 (11.5) | <0.001 | |
| Number of vasoactives (%) | 0 | 2639 (78.3) | 105 (16) | <0.001 | 560 (75) | 43 (17.6) | <0.001 |
| 1 | 391 (11.6) | 98 (14.9) | 108 (14.5) | 49 (20.1) | |||
| 2 | 200 (5.9) | 162 (24.7) | 51 (6.8) | 62 (25.4) | |||
| 3 | 112 (3.3) | 221 (33.7) | 19 (2.5) | 69 (28.3) | |||
| 4 | 27 (0.8) | 70 (10.7) | 9 (1.2) | 21 (8.60) | |||
| Levosimendan (%) | 110 (3.3) | 114 (17.4) | <0.001 | 17 (2.3) | 30 (12.3) | <0.001 | |
| Dobutamine (%) | 419 (12.4) | 400 (61) | <0.001 | 96 (12.9) | 132 (54.1) | <0.001 | |
| Norepinephrine (%) | 560 (16.6) | 500 (76.2) | <0.001 | 151 (20.2) | 186 (76.2) | <0.001 | |
| Vasopressin (%) | 146 (4.3) | 351 (53.5) | <0.001 | 39 (5.2) | 116 (47.5) | <0.001 | |
| MCS (%) | 298 (8.8) | 296 (45.1) | <0.001 | 56 (7.5) | 59 (24.2) | <0.001 | |
| Cardiogenic shock severity | |||||||
| SCAI (%) | E | 207 (6.1) | 360 (54.9) | <0.001 | 51 (6.8) | 123 (50.4) | <0.001 |
| D | 243 (7.2) | 149 (22.7) | 63 (8.4) | 49 (20.1) | |||
| C | 485 (14.4) | 88 (13.4) | 130 (17.4) | 42 (17.2) | |||
| B | 2434 (72.2) | 59 (9) | 503 (67.3) | 30 (12.3) | |||
| Cardiogenic shock outcomes | |||||||
| Stroke (%) | 32 (0.9) | 14 (2.1) | 0.009 | 9 (1.2) | 11 (4.50) | 0.001 | |
| VT/VF (%) | 242 (7.2) | 296 (45.1) | <0.001 | 39 (5.2) | 89 (36.5) | <0.001 | |
| GIB (%) | 41 (1.2) | 52 (7.9) | <0.001 | 16 (2.1) | 14 (5.70) | 0.004 | |
| PE (%) | 0 (0.0) | 0 | NA | 0 (0.0) | 1 (0.40) | 0.246 | |
| AKI (%) | 553 (16.4) | 328 (50) | <0.001 | 180 (24.1) | 127 (52) | <0.001 | |
| Nosocomial pneumonia (%) | 105 (3.1) | 74 (11.3) | <0.001 | 19 (2.5) | 23 (9.40) | <0.001 | |
| Sepsis (%) | 69 (2.0) | 91 (13.9) | <0.001 | 15 (2.0) | 26 (10.7) | <0.001 | |
[i] *NR patients comprise NSTEMI patients or STEMI late presenters that did not have a primary reperfusion.
ACS, acute coronary syndrome; AMI, acute myocardial infarction; AKI, acute kidney injury; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BUN, blood urea nitrogen; CABG, coronary artery bypass grafting; COPD, chronic obstructive pulmonary disease; CRP, C-reactive protein; CS, cardiogenic shock; eGFR, estimated glomerular filtration rate; GIB, gastrointestinal bleeding; LVEF, left ventricular ejection fraction; MCS, mechanical circulatory support; NSTEMI, non-ST segment elevation myocardial infarction; NR, not primary reperfused; PCI, percutaneous coronary intervention; pPCI, primary PCI; PE, pulmonary embolism; PAC, pulmonary artery catheterization; PI, pharmacoinvasive strategy; SCAI, Society for Cardiovascular Angiography and Interventions; STEMI, ST segment elevation myocardial infarction; VF, ventricular fibrillation; VT, ventricular tachycardia.
Table 3
Demographics, clinical parameters, management, and outcomes of patients with non-AMI cardiogenic shock, stratified by sex and survival.
| WOMEN IN NON-AMI-CS | MEN IN NON-AMI-CS | ||||||
|---|---|---|---|---|---|---|---|
| SURVIVORS (n = 1446) | NON-SURVIVORS (n = 536) | P-VALUE | SURVIVORS (n = 1846) | NON-SURVIVORS (n = 586) | P-VALUE | ||
| Age (years) | 63 (50–75) | 63 (50–75) | 0.931 | 60 (46–71) | 60 (46–71) | 0.968 | |
| Body mass index (kg/m2) | 25.39 (22.64–29.38) | 24.78 (22.18–28.35) | 0.002 | 25.78 (23.5–28.48) | 25.39 (23.03–27.76) | 0.005 | |
| Smoking history (%) | 229 (15.8) | 91 (17.0) | 0.054 | 991 (53.7) | 298 (50.9) | 0.232 | |
| Dyslipidemia (%) | 190 (13.1) | 63 (11.8) | 0.411 | 388 (21.0) | 102 (17.4) | 0.058 | |
| Hypertension (%) | 729 (50.4) | 235 (43.8) | 0.009 | 798 (43.2) | 241 (41.1) | 0.37 | |
| COPD (%) | 128 (8.90) | 73 (13.6) | 0.002 | 99 (5.40) | 36 (6.10) | 0.472 | |
| Heart failure history (%) | 554 (38.3) | 272 (50.7) | <0.001 | 953 (51.6) | 342 (58.4) | 0.004 | |
| Chronic kidney disease (%) | 170 (11.8) | 81 (15.1) | 0.046 | 288 (15.6) | 120 (20.5) | 0.006 | |
| Diabetes mellitus (%) | 384 (26.6) | 127 (23.7) | 0.196 | 469 (25.4) | 131 (22.4) | 0.135 | |
| Previous MI (%) | 107 (7.40) | 38 (7.10) | 0.814 | 368 (19.9) | 131 (22.4) | 0.206 | |
| Previous PCI (%) | 45 (3.10) | 17 (3.20) | 0.946 | 185 (10.0) | 60 (10.2) | 0.879 | |
| Previous CABG (%) | 26 (1.80) | 9 (1.70) | 0.858 | 91 (4.90) | 25 (4.30) | 0.512 | |
| Stroke history (%) | 116 (8.00) | 57 (10.6) | 0.067 | 89 (4.80) | 44 (7.50) | 0.013 | |
| Previous atrial fibrillation (%) | 427 (29.5) | 223 (41.6) | <0.001 | 331 (17.9) | 114 (19.5) | 0.406 | |
| Admission vital signs and paraclinical work-up | |||||||
| Systolic blood pressure (mmHg) | 110 (90–136) | 100 (85–120) | <0.001 | 110 (90–130) | 100 (88–120) | <0.001 | |
| Diastolic blood pressure (mmHg) | 67 (60–80) | 60 (50–72) | <0.001 | 69 (60–80) | 60 (50–72) | <0.001 | |
| Medium arterial pressure (mmHg) | 83.33 (70–96.67) | 74.5 (63.33–89.83) | <0.001 | 83.33 (70–95) | 73.33 (64–89.33) | <0.001 | |
| Heart rate (bpm) | 88 (60–110) | 98 (77–115) | <0.001 | 89 (66–109) | 94 (77–110) | <0.001 | |
| Respiratory rate (rpm) | 20 (18–24) | 22 (18–26) | <0.001 | 20 (18–24) | 22 (18–26) | <0.001 | |
| LVEF (%) | 55 (40–60) | 50 (32–60) | <0.001 | 43 (26–58) | 35 (23–55) | <0.001 | |
| Hemoglobin (g/dL) | 12.7 (10.7–14.3) | 12.5 (10.1–14.3) | 0.178 | 14.2 (12.3–15.7) | 13.63 (11.2–15.5) | <0.001 | |
| Leukocytes (c*109 L) | 9.19 (6.83–12.84) | 10.45 (7.2–14.9) | <0.001 | 9.5 (7.47–12.6) | 10.9 (7.7–14.9) | <0.001 | |
| Neutrophils (%) | 76.65 (67.7–85) | 83 (74.6–88.8) | <0.001 | 76.5 (68–84) | 82 (75–88.65) | <0.001 | |
| Platelets (c*109 L) | 206 (155–270) | 163 (112–233) | <0.001 | 194 (150–248) | 164.5 (122–220) | <0.001 | |
| Glucose (mg/dL) | 125 (101–168) | 128.5 (101–171) | 0.551 | 120 (100–154) | 118 (96–165) | 0.418 | |
| BUN (mg/dL) | 26 (16.8–44) | 39 (23–64) | <0.001 | 29 (19–48) | 42 (26–65) | <0.001 | |
| Creatinine (mg/dL) | 1.1 (0.8–1.8) | 1.6 (1.1–2.65) | <0.001 | 1.4 (1–2) | 1.8 (1.3–2.9) | <0.001 | |
| eGFR (mL/min/1.73 m2) | 53.71 (29.67–79.26) | 34.3 (18.66–59) | <0.001 | 56.17 (33.5–81.21) | 39.14 (21.41–62.84) | <0.001 | |
| Chloride (mEq/L) | 101 (97–105) | 99.35 (94–104) | <0.001 | 101.46 (97–105) | 99 (94–103) | <0.001 | |
| Sodium (mEq/L) | 136 (131.42–138.6) | 134 (130–138) | <0.001 | 136 (132–139) | 134 (129–137) | <0.001 | |
| Potassium (mEq/L) | 4.31 (3.9–5) | 4.6 (4.08–5.4) | <0.001 | 4.4 (4–5) | 4.6 (4.1–5.3) | <0.001 | |
| Albumin (g/dL) | 3.44 (3.02–3.8) | 3.16 (2.66–3.6) | <0.001 | 3.49 (3.02–3.87) | 3.15 (2.62–3.6) | <0.001 | |
| AST (UI/L) | 32 (21.09–53.5) | 48 (29.7–104.4) | <0.001 | 33 (22–68) | 55 (30.13–141) | <0.001 | |
| ALT (UI/L) | 26 (16.4–48) | 32 (19–72) | <0.001 | 31 (18.7–69.4) | 39 (22.6–106) | <0.001 | |
| Lactate dehydrogenase (UI/L) | 311.5 (204.4–499) | 499.5 (301–893.5) | <0.001 | 310 (202–528) | 446 (272–771) | <0.001 | |
| C-reactive protein (mg/L) | 17.3 (5.86–54) | 51 (16–120) | <0.001 | 22 (7.4–70.3) | 58.3 (20–130) | <0.001 | |
| 72h – minimum pH | 7.39 (7.34–7.44) | 7.31 (7.19–7.4) | <0.001 | 7.4 (7.35–7.44) | 7.34 (7.21–7.41) | <0.001 | |
| 72h – maximum lactate | 2.3 (1.8–3.1) | 3.3 (2.1–6.35) | <0.001 | 2.3 (1.9–3.2) | 3.2 (2–5.9) | <0.001 | |
| Cardiogenic shock management | |||||||
| PAC (%) | 14 (1.00) | 11 (2.10) | 0.055 | 35 (1.90) | 29 (4.90) | <0.001 | |
| Mechanical ventilation (%) | 166 (11.5) | 251 (46.8) | <0.001 | 190 (10.3) | 292 (49.8) | <0.001 | |
| Hemodialysis (%) | 66 (4.60) | 53 (9.90) | <0.001 | 78 (4.20) | 79 (13.5) | <0.001 | |
| Number of vasoactives (%) | 0 | 1025 (70.9) | 133 (24.8) | <0.001 | 1265 (68.5) | 125 (21.3) | <0.001 |
| 1 | 289 (20.0) | 128 (23.9) | 357 (19.3) | 141 (24.1) | |||
| 2 | 105 (7.30) | 178 (33.2) | 167 (9.00) | 182 (31.1) | |||
| 3 | 22 (1.50) | 88 (16.4) | 45 (2.40) | 117 (20.0) | |||
| 4 | 5 (0.30) | 9 (1.70) | 12 (0.70) | 21 (3.60) | |||
| Levosimendan (%) | 29 (2.00) | 22 (4.10) | 0.009 | 98 (5.30) | 51 (8.70) | 0.003 | |
| Dobutamine (%) | 164 (11.3) | 148 (27.6) | <0.001 | 326 (17.7) | 222 (37.9) | <0.001 | |
| Norepinephrine (%) | 316 (21.9) | 378 (70.5) | <0.001 | 364 (19.7) | 418 (71.3) | <0.001 | |
| Vasopressin (%) | 76 (5.30) | 236 (44.0) | <0.001 | 86 (4.70) | 249 (42.5) | <0.001 | |
| MCS (%) | 19 (1.30) | 8 (1.50) | 0.761 | 36 (2.00) | 14 (2.40) | 0.514 | |
| Cardiogenic shock severity | |||||||
| SCAI (%) | E | 137 (9.50) | 234 (43.7) | <0.001 | 189 (10.2) | 244 (41.6) | <0.001 |
| D | 111 (7.70) | 107 (20.0) | 181 (9.80) | 131 (22.4) | |||
| C | 327 (22.6) | 101 (18.8) | 402 (21.8) | 120 (20.5) | |||
| B | 871 (60.2) | 94 (17.5) | 1074 (58.2) | 91 (15.5) | |||
| Cardiogenic shock outcomes | |||||||
| Stroke (%) | 14 (1.00) | 15 (2.80) | 0.003 | 15 (0.80) | 16 (2.70) | <0.001 | |
| VT/VF (%) | 60 (4.10) | 120 (22.4) | <0.001 | 85 (4.60) | 152 (25.9) | <0.001 | |
| GIB (%) | 16 (1.10) | 29 (5.40) | <0.001 | 26 (1.40) | 23 (3.90) | <0.001 | |
| PE (%) | 5 (0.30) | 2 (0.40) | 1.0 | 4 (0.20) | 4 (0.70) | 0.101 | |
| AKI (%) | 501 (34.6) | 283 (52.8) | <0.001 | 584 (31.6) | 282 (48.1) | <0.001 | |
| Nosocomial pneumonia (%) | 43 (3.00) | 31 (5.80) | 0.003 | 41 (2.20) | 41 (7.00) | <0.001 | |
| Sepsis (%) | 50 (3.50) | 104 (19.4) | <0.001 | 67 (3.60) | 125 (21.3) | <0.001 | |
[i] ACS, acute coronary syndrome; AMI, acute myocardial infarction; AKI, acute kidney injury; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BUN, blood urea nitrogen; CABG, coronary artery bypass grafting; COPD, chronic obstructive pulmonary disease; CRP, C-reactive protein; CS, cardiogenic shock; eGFR, estimated glomerular filtration rate; GIB, gastrointestinal bleeding; LVEF, left ventricular ejection fraction; MCS, mechanical circulatory support; NSTEMI, non-ST segment elevation myocardial infarction; NR, not primary reperfused; PCI, percutaneous coronary intervention; pPCI, primary PCI; PE, pulmonary embolism; PAC, pulmonary artery catheterization; PI, pharmacoinvasive strategy; SCAI, Society for Cardiovascular Angiography and Interventions; STEMI, ST segment elevation myocardial infarction; VF, ventricular fibrillation; VT, ventricular tachycardia.
Figure 2
Cox Forrest of multivariate regression of sex-specific factors related to mortality in AMI-CS in men (A) and women (B); and in non-AMI-CS men (C) and women (D). Blue shade = men, red shade = women.
Figure 3
Kaplan–Meir curves of Acute myocardial infarction (AMI) related cardiogenic shock (CS) in the whole cohort (A) and non-AMI-CS (B) in the whole cohort. The propensity score matched the AMI-CS (C) and non-AMI-CS (D) cohorts. Blue = men, red = women.
Figure 4
Forest plot of sex-based differences in mortality in AMI-CS (acute myocardial infarction–related cardiogenic shock, red) and non–AMI-CS (blue), showing hazard ratios (HR) with 95% confidence intervals (CI) for women versus men across unadjusted, adjusted, and propensity score–matched (PSM) models.