https://doi.org/10.1007/s00392-025-02625-4
1Klinikum Links der Weser Klinik für Innere Medizin II Bremen, Deutschland; 2Klinikum Bremen-Mitte Klinik für Innere Medizin III Bremen, Deutschland; 3Bremer Institut für Herz- und Kreislaufforschung (BIHKF) Bremen, Deutschland
Background: Patients with ST-elevation myocardial infarctions (STEMI) complicated by cardiogenic shock (CS) remain at very high risk despite advances in therapeutic strategies. However, there is few data on the impact of female gender in these patients. Aim of the present study was to assess differences between women and men in patients with STEMI and CS regarding prevalence rates, cardiovascular risk factors and outcome.
Methods: All patients admitted with STEMI were prospectively registered in the Bremen STEMI Registry (BSR). Patients with STEMI complicated by CS between 2006 and 2021 entered analysis and women were compared to men. Predictors for 30-day-mortality were calculated in a multivariate analysis.
Results: Out of a total of 1780 patients admitted with STEMI and CS 499 (28%) were women and 1281 (72%) were men. Over time the number of patients with STEMI and CS increased in women (from 1.8 cases per month in 2006-2010 to 3.5 cases per month in 2016-2021) as well as in men (4.3 in 2006-2010 to 9.2 cases in 2016-2021).
Women with STEMI and CS were on average 6.8 years older than men (70.6 ± 13 yrs. vs. 63.8 ± 12 yrs., p<0.01). They had higher rates of severe obesity (body mass index ≥ 40 kg/m²: 4.1% vs. 2.1%, p=0.03) and lower rates of smoking (22.3% vs. 35.8% p<0.01) compared to men. Despite their higher age women were less likely to present with coronary multivessel disease (64.5% vs. 82.2%, p<0.01).
While rates of primary PCI and successful PCI were similar between women and men (primary PCI: 89.1% vs. 88.3% p=0.59; rate of successful PCI: 91% vs. 92%, p=0.61) female gender was associated with a significantly higher 30-day (53.7% vs. 41.4%, p<0.01) and 1-year mortality (60.2% vs. 48.2%, p<0.01). This disadvantage for women remained in a multivariate model (table).| female sex | age ≥ 65 yrs | prior stroke/TIA | multivessel desease | TIMI3 post PCI | Peak CK > 5.000U/l | LVEF<30% | post PCI resuscitation | |
| HR | 1.4 | 2.4 | 1.4 | 1.7 | 0.6 | 1.5 | 2.5 | 2.9 |
| 95% CI | 1.0-1.9 | 1.7-3.2 | 0.8-2.5 | 1.2-2.4 | 0.4-0.8 | 1.0-2.1 | 1.8-3.6 | 2.1-4.2 |
| p | 0.049 | <0.01 | 0.21 | <0.01 | <0.01 | 0.033 | <0.01 | <0.01 |
Conclusions: Despite comparable rates of primary PCI and procedural success, female gender was independently associated with worse short- and long-term outcomes. More studies are needed to elucidate possible causes for this disadvantage.