Absence of gender differences in clinical outcomes in patients with cardiogenic shock complicating acute myocardial infarction - A report from the SHOCK Trial Registry

Objectives The aim of this study was to assess the impact of gender on clin ical course and in-hospital mortality in patients with cardiogenic shock (C S) complicating acute myocardial infarction (AMI). Background Previous studies have demonstrated higher mortality for women co mpared with men with ST elevation myocardial infarctions and higher rates o f CS after AML The influence of gender and its interaction with various tre atment strategies on clinical outcomes once CS develops is unclear. Methods Using the SHould we emergently revascularize Occluded Coronaries fo r cardiogenic shocK? (SHOCK) Registry database of 1,190 patients with suspe cted CS in the setting of AMI, we examined shock etiologies by gender. Amon g the 884 patients with predominant left ventricular (LV) failure, we compa red the patient demographics, angiographic and hemodynamic findings, treatm ent approaches as well as the clinical outcomes of women versus men. This s tudy had a 97% power to detect a 10% absolute difference in mortality by ge nder. Results Left ventricular failure was the most frequent cause of CS for both gender groups. Women in the SHOCK Registry had a significantly higher inci dence of mechanical complications including ventricular septal rupture and acute severe mitral regurgitation. Among patients with predominant LV failu re, women were, on average, 4.6 years older, had a higher incidence of hype rtension, diabetes and a lower cardiac index. The overall mortality rate fo r the entire cohort was high (61%). After adjustment for differences in pat ient demographics and treatment approaches, there was no significant differ ence in in-hospital mortality between the two gender groups (odds ratio = 1 .03, 95% confidence interval of 0.73 to 1.43, p=0.88). Mortality was also s imilar for women and men who were selected for revascularization (44% vs. 3 8%, p=0.244). Conclusions Women with CS complicating AMI had more frequent adverse clinic al characteristics and mechanical complications. Women derived the same ben efit as men from revascularization, and gender was not independently associ ated with in-hospital mortality in the SHOCK Registry. (J Am Coll Cardiol 2 001;38:1395-401) (C) 2001 by the American College of Cardiology.