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Sex bias in admission to tertiary‐care centres for acute myocardial infarction and cardiogenic shock
Author(s) -
Sambola Antonia,
Elola Francisco Javier,
Buera Irene,
Fernández Cristina,
Bernal José Luis,
Ariza Albert,
Brindis Ralph,
Bueno Héctor,
RodríguezPadial Luis,
Marín Francisco,
Barrabés José Antonio,
Hsia Renee,
Anguita Manuel
Publication year - 2021
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.13526
Subject(s) - cardiogenic shock , myocardial infarction , medicine , cardiology , tertiary care , emergency medicine
Background 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. Methods 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. Results Among 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). Conclusions Women with CS‐STEMI were less referred to tertiary‐care centres and had a higher adjusted in‐hospital mortality than men.