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Gender Differences in Cardiogenic Shock Patients: Clinical Features, Risk Prediction, and Outcomes in a Hub Center

INTRODUCTION: There is scarce knowledge about gender differences in clinical presentation, management, use of risk stratification tools and prognosis in cardiogenic shock (CS) patients. PURPOSE: The primary endpoint was to investigate the differences in characteristics, management, and in-hospital m...

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Autores principales: Lozano-Jiménez, Sara, Iranzo-Valero, Reyes, Segovia-Cubero, Javier, Gómez-Bueno, Manuel, Rivas-Lasarte, Mercedes, Mitroi, Cristina, Escudier-Villa, Juan Manuel, Oteo-Dominguez, Juan Francisco, Vieitez-Florez, Jose María, Villar-García, Susana, Hernández-Pérez, Francisco José
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9326060/
https://www.ncbi.nlm.nih.gov/pubmed/35911539
http://dx.doi.org/10.3389/fcvm.2022.912802
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author Lozano-Jiménez, Sara
Iranzo-Valero, Reyes
Segovia-Cubero, Javier
Gómez-Bueno, Manuel
Rivas-Lasarte, Mercedes
Mitroi, Cristina
Escudier-Villa, Juan Manuel
Oteo-Dominguez, Juan Francisco
Vieitez-Florez, Jose María
Villar-García, Susana
Hernández-Pérez, Francisco José
author_facet Lozano-Jiménez, Sara
Iranzo-Valero, Reyes
Segovia-Cubero, Javier
Gómez-Bueno, Manuel
Rivas-Lasarte, Mercedes
Mitroi, Cristina
Escudier-Villa, Juan Manuel
Oteo-Dominguez, Juan Francisco
Vieitez-Florez, Jose María
Villar-García, Susana
Hernández-Pérez, Francisco José
author_sort Lozano-Jiménez, Sara
collection PubMed
description INTRODUCTION: There is scarce knowledge about gender differences in clinical presentation, management, use of risk stratification tools and prognosis in cardiogenic shock (CS) patients. PURPOSE: The primary endpoint was to investigate the differences in characteristics, management, and in-hospital mortality according to gender in a cohort of CS patients admitted to a tertiary hub center. The secondary endpoint was to evaluate the prognostic performance of the Society of Cardiovascular Angiography and Interventions (SCAI) classification in predicting in-hospital mortality according to sex. METHODS: This is a retrospective single-Center cohort study of CS patients treated by a multidisciplinary shock team between September 2014 and December 2020. Baseline characteristics and clinical outcomes according to gender were registered. Discrimination of SCAI classification was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS: Overall, 163 patients were included, 39 of them female (24%). Mean age of the overall cohort was 55 years (44–62), similar between groups. Compared with men, women were less likely to be smokers and the prevalence of COPD and diabetes mellitus was significantly lower in this group (p < 0.05). Postcardiotomy (44 vs. 31%) and fulminant myocarditis (13 vs. 2%) were more frequent etiologies in females than in males (p = 0.01), whereas acute myocardial infarction was less common among females (13 vs. 33%). Regarding management, the use of temporary mechanical circulatory support, mechanical ventilation, or renal replacement therapy was frequent and no different between the groups (88, 87, and 49%, respectively, in females vs. 42, 91, and 41% in males, p > 0.05). In-hospital survival in the overall cohort was 53%, without differences between groups (52% in females vs. 55% in males, p = 0.76). Most of the patients (60.7%) were in SCAIE at presentation without differences between sexes. The SCAI classification showed a moderate ability for predicting in-hospital mortality (overall, AUC: 0.653, 95% CI 0.582–0.725). The AUC was 0.636 for women (95% CI 0.491–0.780) and 0.658 for men (95% CI 0.575–0.740). CONCLUSIONS: Only one in four of patients treated at a dedicated CS team were female. This may reflect differences in prevalence of severe heart disease at young (<65) ages, although a patient-selection bias cannot be ruled out. In this very high-risk CS population of multiple etiologies, overall, in-hospital survival was slightly above 50% and showed no differences between sexes. Treatment approaches, procedures, and SCAI risk stratification performance did not show gender disparities among treated patients.
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spelling pubmed-93260602022-07-28 Gender Differences in Cardiogenic Shock Patients: Clinical Features, Risk Prediction, and Outcomes in a Hub Center Lozano-Jiménez, Sara Iranzo-Valero, Reyes Segovia-Cubero, Javier Gómez-Bueno, Manuel Rivas-Lasarte, Mercedes Mitroi, Cristina Escudier-Villa, Juan Manuel Oteo-Dominguez, Juan Francisco Vieitez-Florez, Jose María Villar-García, Susana Hernández-Pérez, Francisco José Front Cardiovasc Med Cardiovascular Medicine INTRODUCTION: There is scarce knowledge about gender differences in clinical presentation, management, use of risk stratification tools and prognosis in cardiogenic shock (CS) patients. PURPOSE: The primary endpoint was to investigate the differences in characteristics, management, and in-hospital mortality according to gender in a cohort of CS patients admitted to a tertiary hub center. The secondary endpoint was to evaluate the prognostic performance of the Society of Cardiovascular Angiography and Interventions (SCAI) classification in predicting in-hospital mortality according to sex. METHODS: This is a retrospective single-Center cohort study of CS patients treated by a multidisciplinary shock team between September 2014 and December 2020. Baseline characteristics and clinical outcomes according to gender were registered. Discrimination of SCAI classification was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS: Overall, 163 patients were included, 39 of them female (24%). Mean age of the overall cohort was 55 years (44–62), similar between groups. Compared with men, women were less likely to be smokers and the prevalence of COPD and diabetes mellitus was significantly lower in this group (p < 0.05). Postcardiotomy (44 vs. 31%) and fulminant myocarditis (13 vs. 2%) were more frequent etiologies in females than in males (p = 0.01), whereas acute myocardial infarction was less common among females (13 vs. 33%). Regarding management, the use of temporary mechanical circulatory support, mechanical ventilation, or renal replacement therapy was frequent and no different between the groups (88, 87, and 49%, respectively, in females vs. 42, 91, and 41% in males, p > 0.05). In-hospital survival in the overall cohort was 53%, without differences between groups (52% in females vs. 55% in males, p = 0.76). Most of the patients (60.7%) were in SCAIE at presentation without differences between sexes. The SCAI classification showed a moderate ability for predicting in-hospital mortality (overall, AUC: 0.653, 95% CI 0.582–0.725). The AUC was 0.636 for women (95% CI 0.491–0.780) and 0.658 for men (95% CI 0.575–0.740). CONCLUSIONS: Only one in four of patients treated at a dedicated CS team were female. This may reflect differences in prevalence of severe heart disease at young (<65) ages, although a patient-selection bias cannot be ruled out. In this very high-risk CS population of multiple etiologies, overall, in-hospital survival was slightly above 50% and showed no differences between sexes. Treatment approaches, procedures, and SCAI risk stratification performance did not show gender disparities among treated patients. Frontiers Media S.A. 2022-07-13 /pmc/articles/PMC9326060/ /pubmed/35911539 http://dx.doi.org/10.3389/fcvm.2022.912802 Text en Copyright © 2022 Lozano-Jiménez, Iranzo-Valero, Segovia-Cubero, Gómez-Bueno, Rivas-Lasarte, Mitroi, Escudier-Villa, Oteo-Dominguez, Vieitez-Florez, Villar-García and Hernández-Pérez. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Lozano-Jiménez, Sara
Iranzo-Valero, Reyes
Segovia-Cubero, Javier
Gómez-Bueno, Manuel
Rivas-Lasarte, Mercedes
Mitroi, Cristina
Escudier-Villa, Juan Manuel
Oteo-Dominguez, Juan Francisco
Vieitez-Florez, Jose María
Villar-García, Susana
Hernández-Pérez, Francisco José
Gender Differences in Cardiogenic Shock Patients: Clinical Features, Risk Prediction, and Outcomes in a Hub Center
title Gender Differences in Cardiogenic Shock Patients: Clinical Features, Risk Prediction, and Outcomes in a Hub Center
title_full Gender Differences in Cardiogenic Shock Patients: Clinical Features, Risk Prediction, and Outcomes in a Hub Center
title_fullStr Gender Differences in Cardiogenic Shock Patients: Clinical Features, Risk Prediction, and Outcomes in a Hub Center
title_full_unstemmed Gender Differences in Cardiogenic Shock Patients: Clinical Features, Risk Prediction, and Outcomes in a Hub Center
title_short Gender Differences in Cardiogenic Shock Patients: Clinical Features, Risk Prediction, and Outcomes in a Hub Center
title_sort gender differences in cardiogenic shock patients: clinical features, risk prediction, and outcomes in a hub center
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9326060/
https://www.ncbi.nlm.nih.gov/pubmed/35911539
http://dx.doi.org/10.3389/fcvm.2022.912802
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