• Eur. J. Clin. Invest. · Jul 2021

    Observational Study

    Sex bias in admission to tertiary-care centers for acute myocardial infarction and cardiogenic shock.

    • Antonia Sambola, ElolaFrancisco JavierFJFoundation Institute for Healthcare Improvement, Madrid, Spain., Irene Buera, Cristina Fernández, José Luis Bernal, Albert Ariza, Ralph Brindis, Héctor Bueno, Luis Rodríguez-Padial, Francisco Marín, José Antonio Barrabés, Renee Hsia, and Manuel Anguita.
    • Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain.
    • Eur. J. Clin. Invest. 2021 Jul 1; 51 (7): e13526.

    BackgroundThere are limited data on sex-specific outcomes and management of cardiogenic shock complicating ST-segment elevation myocardial infarction (CS-STEMI). We investigated whether any sex bias exists in the admission to revascularization capable hospitals (RCH) or intensive cardiac care units (ICCU) and its impact on in-hospital mortality.MethodsWe used the Spanish National Health System Minimum Basic Data from 2003 to 2015 to identify patients with CS-STEMI. The primary outcome was sex differences in in-hospital mortality.ResultsAmong 340 490 STEMI patients, 20 262 (6%) had CS and 29.2% were female. CS incidence was higher in women than in men (7.9% vs 5.1%, P = .001). Women were older and had more hypertension and diabetes, and were less often admitted to RCH than men (from 58.7% in 2003 to 79.6% in 2015; and from 61.9% in 2003 to 85.3% in 2015; respectively, P = .01), and to ICCU centres (25.7% vs 29.2%, P = .001). Adjusted mortality was higher in women than men over time (from 79.5 ± 4.3% to 65.8 ± 6.5%; and from 67.8 ± 6% to 58.1 ± 6.5%; respectively, P < .001). ICCU availability was associated with higher use of Percutaneous coronary intervention (PCI) in women (46.8% to 67.2%; P < .001) but was even higher in men (54.8% to 77.4%; P < .001). In ICCU centres, adjusted mortality rates decreased in both sexes, but lower in women (from 74.9 ± 5.4% to 66.3 ± 6.6%) than in men (from 67.8 ± 6.0% to 58.1 ± 6.5%, P < .001). Female sex was an independent predictor of mortality (OR 1.18 95% CI 1.10-1.27, P < .001).ConclusionsWomen with CS-STEMI were less referred to tertiary-care centres and had a higher adjusted in-hospital mortality than men.© 2021 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.

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