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Gender differences in patients with cardiogenic shock complicating myocardial infarction: a substudy of the IABP-SHOCK II-trial

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Abstract

Background

Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) is associated with high mortality. Previous studies regarding gender-specific differences in CS are conflicting and there are insufficient data for the presence of gender-associated differences in the contemporary percutaneous coronary intervention era. Aim of this study was therefore to investigate gender-specific differences in a large cohort of AMI patients with CS undergoing contemporary treatment.

Methods

In the randomized Intra-aortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial, 600 patients with CS complicating AMI undergoing early revascularization were assigned to therapy with or without intra-aortic balloon pump. We compared sex-specific differences in these patients with regard to baseline and procedural characteristics as well as short- and long-term clinical outcome.

Results

Of 600 patients 187 (31 %) were female. Women were significantly older than men and had a significantly lower systolic and diastolic blood pressure at presentation (p < 0.05 for all). Diabetes mellitus and hypertension were more frequent in women, whereas smoking was more frequent in men (p < 0.05 for all). Women showed a higher mortality within the first day after randomization (p = 0.004). However, after multivariable adjustment this numerical difference was no longer statistically significant. No gender-related differences in clinical outcome were observed after 1, 6 and 12 months of follow-up.

Conclusion

In this large-scale multicenter study in patients with CS complicating AMI, women had a worse-risk profile in comparison to men. No significant gender-related differences in treatment as well as short- and long-term outcome were observed.

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Abbreviations

AMI:

Acute myocardial infarction

CABG:

Coronary artery bypass grafting

CS:

Cardiogenic shock

IABP:

Intra-aortic balloon pump

LMCA:

Left-main coronary artery

PCI:

Percutaneous coronary intervention

STEMI:

ST-segment-elevation myocardial infarction

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Acknowledgements

The IABP-SHOCK II-trial has been approved by the local ethics committee at each participating center and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All patients or their legally authorized representatives provided written informed consent. Supported by grants from the German Research Foundation, the German Heart Research Foundation, the German Cardiac Society, Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte, and the University of Leipzig-Heart Center and by unrestricted grants from Maquet Cardiopulmonary and Teleflex Medical.

Conflict of interest

Dr. Thiele reports receiving consulting fees from Eli Lilly, grant support on behalf of his institution from Eli Lilly and Terumo, and lecture fees from AstraZeneca, Boehringer Ingelheim, Daiichi Sankyo, Eli Lilly, the Medicines Company, and Terumo; Dr. Zeymer, serving on the board of Daiichi Sankyo and Eli Lilly and receiving consulting and lecture fees from Daiichi Sankyo, Eli Lilly and the Medicines Company; Dr. Richardt, receiving lecture fees from Maquet Cardiovascular; Dr. Böhm, receiving consulting fees from AstraZeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Medtronic, Merck, Novartis, Pfizer, Sanofi Aventis, and Servier and lecture fees from AstraZeneca, AWD.pharma Dresden, Bayer, Berlin-Chemie, Boehringer Ingelheim, Daiichi Sankyo, Merck, Novartis, Pfizer, Sanofi Aventis, and Servier; Dr. Schneider, serving on the ethics committee of Landesärztekammer Baden-Württemberg, receiving payment for manuscript preparation from Biosense Webster, Grupo Ferrer, and Nycomed, and receiving money on behalf of the clinical research organization at his institution from Abbott Vascular, AstraZeneca, Bayer Schering, Bayer Vital, Biotronik, Bristol-Myers Squibb, Boehringer Ingelheim, Cordis, Daiichi Sankyo, Diagenics, Enverdis, Eli Lilly GlaxoSmithKline, Guidant, IKKF, Impulse Dynamics, Medtronic, Merck, Novartis, Roche Diagnostics, Sanofi Aventis, Schering-Plough, Siemens, St. Jude Medical, Takeda Pharma, Tromssdorff, and Vifor Pharma; and Dr. Werdan serving on the board of Biotest and Servier, receiving grant support on behalf of his institution from Biotest and Servier, and receiving lecture fees from Biotest, Brahms, Maquet Cardiovascular, and Servier. No other potential conflict of interest relevant to this article was reported.

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Authors and Affiliations

  1. Department of Internal Medicine, Cardiology, University of Leipzig, Heart Center, Strümpellstraße 39, 04289, Leipzig, Germany

    Karl Fengler, Georg Fuernau & Gerhard Schuler

  2. Department of Internal Medicine II, University of Lübeck, Lübeck, Germany

    Steffen Desch, Ingo Eitel, Janine Poess & Holger Thiele

  3. Department of Cardiology, University of Freiburg, Bad Krozingen Heart Center, Bad Krozingen, Germany

    Franz-Josef Neumann

  4. Department of Internal Medicine I, Hospital Langen, Langen, Germany

    Hans-Georg Olbrich

  5. Department of Cardiology, German Heart Center Munich, Munich, Germany

    Antoinette de Waha

  6. Department of Cardiology, Angiology, Bad Segeberg Heart Center, Bad Segeberg, Germany

    Suzanne de Waha & Gert Richardt

  7. Department of Internal Medicine I, Klinikum am Gesundbrunnen, Heilbronn, Germany

    Marcus Hennersdorf

  8. Department of Internal Medicine B, University of Greifswald, Greifswald, Germany

    Klaus Empen

  9. Department of Cardiology, Angiology, Klinikum links der Weser, Bremen, Germany

    Rainer Hambrecht

  10. Department of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany

    Jörg Fuhrmann

  11. Department of Internal Medicine III, University of Homburg, Homburg, Saar, Germany

    Michael Böhm

  12. Department of Internal Medicine, Cardiology, University of Dresden, Heart Center, Dresden, Germany

    Ruth Strasser

  13. Institut für Herzinfarktforschung, Ludwigshafen, Germany

    Steffen Schneider & Uwe Zeymer

  14. Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, Halle, Saale, Germany

    Karl Werdan

Authors
  1. Karl Fengler
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  2. Georg Fuernau
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  3. Steffen Desch
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  4. Ingo Eitel
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  5. Franz-Josef Neumann
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  6. Hans-Georg Olbrich
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  7. Antoinette de Waha
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  8. Suzanne de Waha
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  9. Gert Richardt
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  10. Marcus Hennersdorf
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  11. Klaus Empen
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  12. Rainer Hambrecht
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  13. Jörg Fuhrmann
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  14. Michael Böhm
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  15. Janine Poess
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  16. Ruth Strasser
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  17. Steffen Schneider
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  18. Gerhard Schuler
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  19. Karl Werdan
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  20. Uwe Zeymer
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  21. Holger Thiele
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Corresponding author

Correspondence to Georg Fuernau.

Additional information

K. Fengler and G. Fuernau contributed equally to this study.

Clinicaltrials.gov: NCT00491036.

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Fengler, K., Fuernau, G., Desch, S. et al. Gender differences in patients with cardiogenic shock complicating myocardial infarction: a substudy of the IABP-SHOCK II-trial. Clin Res Cardiol 104, 71–78 (2015). https://doi.org/10.1007/s00392-014-0767-2

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  • DOI: https://doi.org/10.1007/s00392-014-0767-2

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