Absence of gender differences in clinical outcomes in patients with cardiogenic shock complicating acute myocardial infarction: A Report From the SHOCK Trial Registry

S. Chiu Wong, Lynn A. Sleeper, E. Scott Monrad, Mark A. Menegus, Angela Palazzo, Vladimir Dzavik, Alice Jacobs, Xianjiao Jiang, Judith S. Hochman

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

OBJECTIVES: The aim of this study was to assess the impact of gender on clinical course and in-hospital mortality in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI). BACKGROUND: Previous studies have demonstrated higher mortality for women compared with men with ST elevation myocardial infarctions and higher rates of CS after AMI, The influence of gender and its interaction with various treatment strategies on clinical outcomes once CS develops is unclear. METHODS: Using the SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? (SHOCK) Registry database of 1,190 patients with suspected CS in the setting of AMI, we examined shock etiologies by gender. Among the 884 patients with predominant left ventricular (LV) failure, we compared the patient demographics, angiographic and hemodynamic findings, treatment approaches as well as the clinical outcomes of women versus men. This study had a 97% power to detect a 10% absolute difference in mortality by gender. RESULTS: Left ventricular failure was the most frequent cause of CS for both gender groups. Women in the SHOCK Registry had a significantly higher incidence of mechanical complications including ventricular septal rupture and acute severe mitral regurgitation. Among patients with predominant LV failure, women were, on average, 4.6 years older, had a higher incidence of hypertension, diabetes and a lower cardiac index. The overall mortality rate for the entire cohort was high (61%). After adjustment for differences in patient demographics and treatment approaches, there was no significant difference 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 similar for women and men who were selected for revascularization (44% vs. 38%, p = 0.244). CONCLUSIONS: Women with CS complicating AMI had more frequent adverse clinical characteristics and mechanical complications. Women derived the same benefit as men from revascularization, and gender was not independently associated with in-hospital mortality in the SHOCK Registry.

Original languageEnglish (US)
Pages (from-to)1395-1401
Number of pages7
JournalJournal of the American College of Cardiology
Volume38
Issue number5
DOIs
StatePublished - Nov 1 2001

Fingerprint

Cardiogenic Shock
Registries
Myocardial Infarction
Hospital Mortality
Mortality
Ventricular Septal Rupture
Demography
Incidence
Mitral Valve Insufficiency
Shock
Therapeutics
Hemodynamics
Odds Ratio
Databases
Confidence Intervals
Hypertension

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Absence of gender differences in clinical outcomes in patients with cardiogenic shock complicating acute myocardial infarction : A Report From the SHOCK Trial Registry. / Wong, S. Chiu; Sleeper, Lynn A.; Monrad, E. Scott; Menegus, Mark A.; Palazzo, Angela; Dzavik, Vladimir; Jacobs, Alice; Jiang, Xianjiao; Hochman, Judith S.

In: Journal of the American College of Cardiology, Vol. 38, No. 5, 01.11.2001, p. 1395-1401.

Research output: Contribution to journalArticle

Wong, S. Chiu ; Sleeper, Lynn A. ; Monrad, E. Scott ; Menegus, Mark A. ; Palazzo, Angela ; Dzavik, Vladimir ; Jacobs, Alice ; Jiang, Xianjiao ; Hochman, Judith S. / Absence of gender differences in clinical outcomes in patients with cardiogenic shock complicating acute myocardial infarction : A Report From the SHOCK Trial Registry. In: Journal of the American College of Cardiology. 2001 ; Vol. 38, No. 5. pp. 1395-1401.
@article{488d3f8d219a42f391ad3f96bc0d93c6,
title = "Absence of gender differences in clinical outcomes in patients with cardiogenic shock complicating acute myocardial infarction: A Report From the SHOCK Trial Registry",
abstract = "OBJECTIVES: The aim of this study was to assess the impact of gender on clinical course and in-hospital mortality in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI). BACKGROUND: Previous studies have demonstrated higher mortality for women compared with men with ST elevation myocardial infarctions and higher rates of CS after AMI, The influence of gender and its interaction with various treatment strategies on clinical outcomes once CS develops is unclear. METHODS: Using the SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? (SHOCK) Registry database of 1,190 patients with suspected CS in the setting of AMI, we examined shock etiologies by gender. Among the 884 patients with predominant left ventricular (LV) failure, we compared the patient demographics, angiographic and hemodynamic findings, treatment approaches as well as the clinical outcomes of women versus men. This study had a 97{\%} power to detect a 10{\%} absolute difference in mortality by gender. RESULTS: Left ventricular failure was the most frequent cause of CS for both gender groups. Women in the SHOCK Registry had a significantly higher incidence of mechanical complications including ventricular septal rupture and acute severe mitral regurgitation. Among patients with predominant LV failure, women were, on average, 4.6 years older, had a higher incidence of hypertension, diabetes and a lower cardiac index. The overall mortality rate for the entire cohort was high (61{\%}). After adjustment for differences in patient demographics and treatment approaches, there was no significant difference 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 similar for women and men who were selected for revascularization (44{\%} vs. 38{\%}, p = 0.244). CONCLUSIONS: Women with CS complicating AMI had more frequent adverse clinical characteristics and mechanical complications. Women derived the same benefit as men from revascularization, and gender was not independently associated with in-hospital mortality in the SHOCK Registry.",
author = "Wong, {S. Chiu} and Sleeper, {Lynn A.} and Monrad, {E. Scott} and Menegus, {Mark A.} and Angela Palazzo and Vladimir Dzavik and Alice Jacobs and Xianjiao Jiang and Hochman, {Judith S.}",
year = "2001",
month = "11",
day = "1",
doi = "10.1016/S0735-1097(01)01581-9",
language = "English (US)",
volume = "38",
pages = "1395--1401",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "5",

}

TY - JOUR

T1 - Absence of gender differences in clinical outcomes in patients with cardiogenic shock complicating acute myocardial infarction

T2 - A Report From the SHOCK Trial Registry

AU - Wong, S. Chiu

AU - Sleeper, Lynn A.

AU - Monrad, E. Scott

AU - Menegus, Mark A.

AU - Palazzo, Angela

AU - Dzavik, Vladimir

AU - Jacobs, Alice

AU - Jiang, Xianjiao

AU - Hochman, Judith S.

PY - 2001/11/1

Y1 - 2001/11/1

N2 - OBJECTIVES: The aim of this study was to assess the impact of gender on clinical course and in-hospital mortality in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI). BACKGROUND: Previous studies have demonstrated higher mortality for women compared with men with ST elevation myocardial infarctions and higher rates of CS after AMI, The influence of gender and its interaction with various treatment strategies on clinical outcomes once CS develops is unclear. METHODS: Using the SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? (SHOCK) Registry database of 1,190 patients with suspected CS in the setting of AMI, we examined shock etiologies by gender. Among the 884 patients with predominant left ventricular (LV) failure, we compared the patient demographics, angiographic and hemodynamic findings, treatment approaches as well as the clinical outcomes of women versus men. This study had a 97% power to detect a 10% absolute difference in mortality by gender. RESULTS: Left ventricular failure was the most frequent cause of CS for both gender groups. Women in the SHOCK Registry had a significantly higher incidence of mechanical complications including ventricular septal rupture and acute severe mitral regurgitation. Among patients with predominant LV failure, women were, on average, 4.6 years older, had a higher incidence of hypertension, diabetes and a lower cardiac index. The overall mortality rate for the entire cohort was high (61%). After adjustment for differences in patient demographics and treatment approaches, there was no significant difference 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 similar for women and men who were selected for revascularization (44% vs. 38%, p = 0.244). CONCLUSIONS: Women with CS complicating AMI had more frequent adverse clinical characteristics and mechanical complications. Women derived the same benefit as men from revascularization, and gender was not independently associated with in-hospital mortality in the SHOCK Registry.

AB - OBJECTIVES: The aim of this study was to assess the impact of gender on clinical course and in-hospital mortality in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI). BACKGROUND: Previous studies have demonstrated higher mortality for women compared with men with ST elevation myocardial infarctions and higher rates of CS after AMI, The influence of gender and its interaction with various treatment strategies on clinical outcomes once CS develops is unclear. METHODS: Using the SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? (SHOCK) Registry database of 1,190 patients with suspected CS in the setting of AMI, we examined shock etiologies by gender. Among the 884 patients with predominant left ventricular (LV) failure, we compared the patient demographics, angiographic and hemodynamic findings, treatment approaches as well as the clinical outcomes of women versus men. This study had a 97% power to detect a 10% absolute difference in mortality by gender. RESULTS: Left ventricular failure was the most frequent cause of CS for both gender groups. Women in the SHOCK Registry had a significantly higher incidence of mechanical complications including ventricular septal rupture and acute severe mitral regurgitation. Among patients with predominant LV failure, women were, on average, 4.6 years older, had a higher incidence of hypertension, diabetes and a lower cardiac index. The overall mortality rate for the entire cohort was high (61%). After adjustment for differences in patient demographics and treatment approaches, there was no significant difference 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 similar for women and men who were selected for revascularization (44% vs. 38%, p = 0.244). CONCLUSIONS: Women with CS complicating AMI had more frequent adverse clinical characteristics and mechanical complications. Women derived the same benefit as men from revascularization, and gender was not independently associated with in-hospital mortality in the SHOCK Registry.

UR - http://www.scopus.com/inward/record.url?scp=0035499993&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035499993&partnerID=8YFLogxK

U2 - 10.1016/S0735-1097(01)01581-9

DO - 10.1016/S0735-1097(01)01581-9

M3 - Article

C2 - 11691514

AN - SCOPUS:0035499993

VL - 38

SP - 1395

EP - 1401

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 5

ER -