Background:Women are more likely to suffer and die from cardiogenic shock (CS) as the most severe complication of acute myocardial infarction. Data concerning optimal management for women with CS are scarce. Aim of this study was to better define characteristics of women experiencing CS and to the influence of sex on different treatment strategies.Methods:In the CULPRIT-SHOCK trial (The Culprit Lesion Only PCI Versus Multivessel PCI in Cardiogenic Shock), patients with CS complicating acute myocardial infarction and multivessel coronary artery disease were randomly assigned to one of the following revascularization strategies: either percutaneous coronary intervention of the culprit-lesion-only or immediate multivessel percutaneous coronary intervention. Primary end point was composite of death from any cause or severe renal failure leading to renal replacement therapy within 30 days. We investigated sex-specific differences in general and according to the revascularization strategies.Results:Among all 686 randomized patients included in the analysis, 24% were women. Women were older and had more often diabetes mellitus and renal insufficiency, whereas they had less often history of previous acute myocardial infarction and smoking. After 30 days, the primary clinical end point was not significantly different between groups (56% women versus 49% men; odds ratio, 1.29 [95% CI, 0.91–1.84]; P=0.15). There was no interaction between sex and coronary revascularization strategy regarding mortality and renal failure (P_interaction=0.11). The primary end point occurred in 56% of women treated by the culprit-lesion-only strategy versus 42% men, whereas 55% of women and 55% of men in the multivessel percutaneous coronary intervention group.Conclusions:Although women presented with a different risk profile, mortality and renal replacement were similar to men. Sex did not influence mortality and renal failure according to the different coronary revascularization strategies. Based on these data, women and men presenting with CS complicating acute myocardial infarction and multivessel coronary artery disease should not be treated differently. However, further randomized trials powered to address potential sex-specific differences in CS are still necessary.Registration:URL: https://www.clinicaltrials.gov; Unique identifier: NCT01927549.

中文翻译：

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急性心肌梗死和心源性休克患者的性别管理

背景：作为急性心肌梗塞最严重的并发症，女性更容易遭受心源性休克（CS）的折磨和死亡。缺乏有关CS患者最佳治疗的数据。这项研究的目的是更好地定义经历CS的女性的特征以及性别对不同治疗策略的影响。方法：在CULPRIT-SHOCK试验（心源性休克中仅使用Culprit病变的PCI与多支PCI进行比较）中，CS患者变得复杂急性心肌梗塞和多支冠状动脉疾病被随机分配至以下血运重建策略之一：仅对病变部位进行经皮冠状动脉介入治疗，或即刻进行多支血管经皮冠状动脉介入治疗。主要终点是30天之内因任何原因引起的死亡或严重的肾功能衰竭导致的肾脏替代治疗。结果：在分析的所有686例随机患者中，女性占24％。女性年龄较大，糖尿病和肾功能不全的发生率较高，而以前有急性心肌梗塞和吸烟史的女性较少。30天后，各组间的主要临床终点无显着差异（56％的女性与49％的男性；比值比为1.29 [95％CI，0.91-1.84]；妇女占24％。女性年龄较大，糖尿病和肾功能不全的发生率较高，而以前有急性心肌梗塞和吸烟史的女性较少。30天后，各组间的主要临床终点无显着差异（56％的女性与49％的男性；优势比为1.29 [95％CI，0.91-1.84]；妇女占24％。女性年龄较大，糖尿病和肾功能不全的发生率较高，而以前有急性心肌梗塞和吸烟史的女性较少。30天后，各组间的主要临床终点无显着差异（56％的女性与49％的男性；比值比为1.29 [95％CI，0.91-1.84]；P＝ 0.15）。在死亡率和肾衰竭方面，性别和冠脉血运重建策略之间没有相互作用（P_相互作用= 0.11）。主要终点事件发生在仅采用罪魁祸首策略的女性中，而在多支血管经皮冠状动脉介入治疗组中，女性的这一比例为42％，而男性为55％，女性为55％，男性为55％。危险性，死亡率和肾脏替代与男性相似。根据不同的冠状动脉血运重建策略，性别不会影响死亡率和肾衰竭。根据这些数据，患有CS并发急性心肌梗塞和多支冠状动脉疾病的男女不应区别对待。但是，仍然有必要进行进一步的随机试验以解决CS中潜在的性别差异，该注册网址：https：//www.clinicaltrials.gov；唯一标识符：NCT01927549。