TY - JOUR
T1 - Gender Disparities on the Use and Outcomes of Mechanical Circulatory Support in Patients With Cardiogenic Shock Complicating Acute Myocardial Infarction
AU - Diaz-Arocutipa, Carlos
AU - Gamarra-Valverde, Norma Nicole
AU - Salguero, Rafael
AU - Martín-Asenjo, Roberto
AU - Vicent, Lourdes
N1 - Publisher Copyright:
© 2024 Elsevier Inc.
PY - 2024/12/15
Y1 - 2024/12/15
N2 - Cardiogenic shock complicating acute myocardial infarction (AMI-CS) remains a critical condition with high morbimortality. Despite advances, gender disparities persist in the management of this condition. Our aim was to evaluate gender differences in the utilization and outcomes of mechanical circulatory support (MCS) in AMI-CS. In addition, we addressed the management strategies for AMI-CS stratified by race/ethnicity. We performed a retrospective study using the National Inpatient Sample from 2016 to 2019, including admissions with AMI-CS. The use of MCS and outcomes were compared between genders using inverse probability of treatment weighting. Odds ratios (OR) with their 95% confidence interval (CI) were estimated. A total of 151,560 admissions for AMI-CS were analyzed, including 98,855 male and 52,705 female patients. After the inverse probability of treatment weighting adjustment, females were significantly less likely to receive MCS (OR 0.77, 95% CI 0.73 to 0.81, p <0.001) and had higher in-hospital mortality rates (OR 1.09, 95% CI 1.00 to 1.18, p = 0.045) than males. No significant gender differences were observed in major bleeding, renal replacement therapy, or mechanical ventilation. Racial disparities were also evident, with female patients across all racial groups being less likely to receive MCS compared with their male counterparts. In conclusion, significant gender disparities exist in the utilization and outcomes of MCS in patients with AMI-CS. Female patients are less likely to receive MCS and have higher in-hospital mortality rates compared with male patients. Racial minorities, including Black and Hispanic patients, experience lower utilization of MCS compared with White patients. These findings underscore the complex interplay between gender, race/ethnicity, and health care access and outcomes.
AB - Cardiogenic shock complicating acute myocardial infarction (AMI-CS) remains a critical condition with high morbimortality. Despite advances, gender disparities persist in the management of this condition. Our aim was to evaluate gender differences in the utilization and outcomes of mechanical circulatory support (MCS) in AMI-CS. In addition, we addressed the management strategies for AMI-CS stratified by race/ethnicity. We performed a retrospective study using the National Inpatient Sample from 2016 to 2019, including admissions with AMI-CS. The use of MCS and outcomes were compared between genders using inverse probability of treatment weighting. Odds ratios (OR) with their 95% confidence interval (CI) were estimated. A total of 151,560 admissions for AMI-CS were analyzed, including 98,855 male and 52,705 female patients. After the inverse probability of treatment weighting adjustment, females were significantly less likely to receive MCS (OR 0.77, 95% CI 0.73 to 0.81, p <0.001) and had higher in-hospital mortality rates (OR 1.09, 95% CI 1.00 to 1.18, p = 0.045) than males. No significant gender differences were observed in major bleeding, renal replacement therapy, or mechanical ventilation. Racial disparities were also evident, with female patients across all racial groups being less likely to receive MCS compared with their male counterparts. In conclusion, significant gender disparities exist in the utilization and outcomes of MCS in patients with AMI-CS. Female patients are less likely to receive MCS and have higher in-hospital mortality rates compared with male patients. Racial minorities, including Black and Hispanic patients, experience lower utilization of MCS compared with White patients. These findings underscore the complex interplay between gender, race/ethnicity, and health care access and outcomes.
KW - acute myocardial infarction
KW - cardiogenic shock
KW - gender disparities
KW - mechanical circulatory support
KW - racial disparities
UR - http://www.scopus.com/inward/record.url?scp=85207004838&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2024.09.031
DO - 10.1016/j.amjcard.2024.09.031
M3 - Artículo
C2 - 39395593
AN - SCOPUS:85207004838
SN - 0002-9149
VL - 233
SP - 65
EP - 73
JO - American Journal of Cardiology
JF - American Journal of Cardiology
ER -