Maria Rubini Gimenez1,2, Uwe Zeymer3, Steffen Desch1,4, Suzanne de Waha-Thiele5, Taoufik Ouarrak6, Janine Poess5, Roza Meyer-Saraei4,5, Steffen Schneider6, Georg Fuernau4,5, Janina Stepinska7, Kurt Huber8, Stephan Windecker9, Gilles Montalescot10, Stefano Savonitto11, Raban V Jeger2, Holger Thiele1. 1. From the Department of Internal Medicine/Cardiology, Heart Center Leipzig, Germany (M.R.G., S.D., H.T.). 2. Cardiology Department, University Hospital Basel, Switzerland (M.R.G., R.V.J.). 3. Klinikum Ludwigshafen, Germany (U.Z.). 4. German Center for Cardiovascular Research, Berlin, Germany (S.D., R.M.-S., G.F.). 5. Department of Internal Medicine/Cardiology/ Angiology/Intensive Care Medicine, University Heart Center Lübeck, Germany (S.d.W.-T., J.P., R.M.-S., G.F.). 6. Institut für Herzinfarktforschung, Ludwigshafen, Germany (T.O., S.S.). 7. Institute of Cardiology, Warsaw, Poland (J.S.). 8. 3rd Department of Internal Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital and Sigmund Freud University, Medical School, Vienna, Austria (K.H.). 9. Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (S.W.). 10. Department of Cardiology, Sorbonne Université, Institut de Cardiologie (AP-HP), hôpital Pitié Salpêtrière, Paris, France (G.M.). 11. Department of Cardiology, Manzoni Hospital, Lecco, Italy (S.S.).
Abstract
BACKGROUND: Women are more likely to suffer and die from cardiogenic shock (CS) as the most severe complication of acute myocardial infarction. Data concerning optimal management for women with CS are scarce. Aim of this study was to better define characteristics of women experiencing CS and to the influence of sex on different treatment strategies. METHODS: In the CULPRIT-SHOCK trial (The Culprit Lesion Only PCI Versus Multivessel PCI in Cardiogenic Shock), patients with CS complicating acute myocardial infarction and multivessel coronary artery disease were randomly assigned to one of the following revascularization strategies: either percutaneous coronary intervention of the culprit-lesion-only or immediate multivessel percutaneous coronary intervention. Primary end point was composite of death from any cause or severe renal failure leading to renal replacement therapy within 30 days. We investigated sex-specific differences in general and according to the revascularization strategies. RESULTS: Among all 686 randomized patients included in the analysis, 24% were women. Women were older and had more often diabetes mellitus and renal insufficiency, whereas they had less often history of previous acute myocardial infarction and smoking. After 30 days, the primary clinical end point was not significantly different between groups (56% women versus 49% men; odds ratio, 1.29 [95% CI, 0.91-1.84]; P=0.15). There was no interaction between sex and coronary revascularization strategy regarding mortality and renal failure (Pinteraction=0.11). The primary end point occurred in 56% of women treated by the culprit-lesion-only strategy versus 42% men, whereas 55% of women and 55% of men in the multivessel percutaneous coronary intervention group. CONCLUSIONS: Although women presented with a different risk profile, mortality and renal replacement were similar to men. Sex did not influence mortality and renal failure according to the different coronary revascularization strategies. Based on these data, women and men presenting with CS complicating acute myocardial infarction and multivessel coronary artery disease should not be treated differently. However, further randomized trials powered to address potential sex-specific differences in CS are still necessary. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01927549.
RCT Entities:
BACKGROUND:Women are more likely to suffer and die from cardiogenic shock (CS) as the most severe complication of acute myocardial infarction. Data concerning optimal management for women with CS are scarce. Aim of this study was to better define characteristics of women experiencing CS and to the influence of sex on different treatment strategies. METHODS: In the CULPRIT-SHOCK trial (The Culprit Lesion Only PCI Versus Multivessel PCI in Cardiogenic Shock), patients with CS complicating acute myocardial infarction and multivessel coronary artery disease were randomly assigned to one of the following revascularization strategies: either percutaneous coronary intervention of the culprit-lesion-only or immediate multivessel percutaneous coronary intervention. Primary end point was composite of death from any cause or severe renal failure leading to renal replacement therapy within 30 days. We investigated sex-specific differences in general and according to the revascularization strategies. RESULTS: Among all 686 randomized patients included in the analysis, 24% were women. Women were older and had more often diabetes mellitus and renal insufficiency, whereas they had less often history of previous acute myocardial infarction and smoking. After 30 days, the primary clinical end point was not significantly different between groups (56% women versus 49% men; odds ratio, 1.29 [95% CI, 0.91-1.84]; P=0.15). There was no interaction between sex and coronary revascularization strategy regarding mortality and renal failure (Pinteraction=0.11). The primary end point occurred in 56% of women treated by the culprit-lesion-only strategy versus 42% men, whereas 55% of women and 55% of men in the multivessel percutaneous coronary intervention group. CONCLUSIONS: Although women presented with a different risk profile, mortality and renal replacement were similar to men. Sex did not influence mortality and renal failure according to the different coronary revascularization strategies. Based on these data, women and men presenting with CS complicating acute myocardial infarction and multivessel coronary artery disease should not be treated differently. However, further randomized trials powered to address potential sex-specific differences in CS are still necessary. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01927549.
Entities:
Keywords:
humans; myocardial infarction; shock, cardiogenic; smoking; women
Authors: Saraschandra Vallabhajosyula; Lina Ya'Qoub; Mandeep Singh; Malcolm R Bell; Rajiv Gulati; Wisit Cheungpasitporn; Pranathi R Sundaragiri; Virginia M Miller; Allan S Jaffe; Bernard J Gersh; David R Holmes; Gregory W Barsness Journal: Circ Heart Fail Date: 2020-09-29 Impact factor: 8.790
Authors: Isabell Yan; Benedikt Schrage; Jessica Weimann; Salim Dabboura; Rafel Hilal; Benedikt N Beer; Peter Moritz Becher; Moritz Seiffert; Christina Magnussen; Renate B Schnabel; Paulus Kirchhof; Stefan Blankenberg; Dirk Westermann Journal: ESC Heart Fail Date: 2021-03-24
Authors: Sara Lozano-Jiménez; Reyes Iranzo-Valero; Javier Segovia-Cubero; Manuel Gómez-Bueno; Mercedes Rivas-Lasarte; Cristina Mitroi; Juan Manuel Escudier-Villa; Juan Francisco Oteo-Dominguez; Jose María Vieitez-Florez; Susana Villar-García; Francisco José Hernández-Pérez Journal: Front Cardiovasc Med Date: 2022-07-13
Authors: N Ghionzoli; C Sciaccaluga; G E Mandoli; G Vergaro; F Gentile; F D'Ascenzi; S Mondillo; M Emdin; S Valente; M Cameli Journal: Heart Fail Rev Date: 2020-10-02 Impact factor: 4.214