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

Abstract

There 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. We 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. Among 340490 STEMI patients, 20262 (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). Women with CS-STEMI were less referred to tertiary-care centres and had a higher adjusted in-hospital mortality than men.