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Background <p>Cardiogenic shock (CS) remains the leading cause of death in acute myocardial infarction (AMI). Sex-related disparities in AMI-CS have been reported, but findings vary across cohorts.</p> Objectives <p>The authors examined the clinical characteristics and in-hospital outcomes of consecutive women and men with AMI-CS.</p> Methods <p>The ALKK coronary angiography (CAG) registry prospectively enrolled consecutive CAG and percutaneous coronary interventions (PCI) across 51 participating hospitals in Germany.</p> Results <p>Between January 2009 and December 2020, a total of 4204 patients undergoing CAG for suspected AMI-CS were included. Women (30.5%, <i>n</i> = 1281) were on average 6&#xa0;years older (74.3 vs. 68.0&#xa0;years, <i>P</i> &lt; .001) and had more comorbidities. They less frequently had significant coronary artery disease (CAD), 82.3% vs. 90.3%, <i>P</i> &lt; .001. No significant sex differences in the recommendation for revascularization (PCI or CABG) among patients with significant CAD after adjustment for age (92.4% vs. 91.3%, adjusted OR: 1.3; 95% CI: 0.99–1.72) were observed. There were no sex differences in hospital mortality after adjustment for age, particularly in the PCI group, age-adjusted OR: 1.06; 95% CI: 0.90–1.25, multivariable adjusted OR: 1.09; 95% CI: 0.92–1.28.</p> Conclusions <p>In this large, contemporary registry, women with early CAG for AMI-CS were older than men and had more comorbidities. Significant CAD was less frequently diagnosed in women with suspected AMI-CS. After adjustment for age, there were neither sex differences in revascularization strategies nor in hospital mortality after PCI for AMI-CS. These results question previous reports about undertreatment and higher mortality of AMI-CS in women.</p> Graphical Abstract <p></p>

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Sex disparities in revascularization strategies and mortality

  • 期刊论文

  • 发表日期：

    2026年7月30日

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  • Tobias Heer,
  • Matthias Hochadel,
  • Holger Thiele,
  • Sebastian Kerber,
  • Julinda Mehilli,
  • Bernward Lauer,
  • Ralf Zahn,
  • Uwe Zeymer,
  • Jochen Senges,
  • Albrecht Elsässer,
  • Karl-E. Hauptmann,
  • Nikos Werner,
  • Thomas Budde,
  • Hagen Kälsch,
  • Harald Darius,
  • Huseyin Ince,
  • Johannes Brachmann,
  • Mohammed Saad,
  • Steffen Behrens,
  • Bernhard Zrenner,
  • Wilfried Kramer,
  • Martin Brück,
  • Jobst Isbary,
  • Thomas Brummer,
  • Christian Vollmer,
  • H.-G. Glunz,
  • Burghard Schumacher,
  • Dietrich Andresen,
  • Hüseyin Ince,
  • Philipp Lauten,
  • Volker Schächinger,
  • Stephan Kische,
  • Christian Zellerhoff,
  • Harald Mudra,
  • Stefan Sack,
  • Helmut Schühlen,
  • Dietlind Zohlhöfer-Momm,
  • Wolfgang von Scheidt,
  • Philip Raake,
  • Peter Lanzer,
  • Axel Tamke,
  • Wolfram Terres,
  • Eberhard Schulz,
  • Reinhard K. Klocke,
  • Achim Gutersohn,
  • Martin Eberhard Beyer,
  • Thorsten Beck,
  • Martin Beyer,
  • Conrad Pfafferott,
  • Karlheinz Seidl,
  • Blerim Luani,
  • Rolf Engberding,
  • Claus Fleischmann,
  • Marco R. Schroeter,
  • Birgit Hailer,
  • Martin Sigmund,
  • Wolfgang Ferrari,
  • Stefan Holmer,
  • Hubert Topp,
  • Daniel Griese,
  • Wolfgang Kasper,
  • Joachim Ehrlich,
  • Norbert Kaul,
  • Dietmar Burkhardt,
  • Günter Görge,
  • Florian Custodis,
  • Heinz Kahles,
  • Carsten Zobel,
  • Mathias Elsner,
  • Nevin Yilmaz-Zeytin,
  • Michael F. D. Kentsch,
  • Christian Eickholt,
  • Semi Sen,
  • Christoph Kadel,
  • Ulrich Hink,
  • Jürgen Tebbenjohanns,
  • Harald Klepzig,
  • Timm Bauer,
  • Rainer Uebis,
  • Mark Rosenberg,
  • Ralph Schöller,
  • Christian Opitz,
  • Bettina Götting,
  • Fadi Al Abdullah,
  • Walter Notheis,
  • Andreas Strauss,
  • Wolfgang Andreas Schöbel,
  • Rainer Schamberger,
  • Oliver Zagorski,
  • Friedrich Seidel,
  • Jan Torzewski,
  • Michael A. J. Weber,
  • Bernhard Witzenbichler,
  • Hans F. Vöhringer,
  • Iskandar Atmowihardjo,
  • Thomas Zimmer,
  • Brigitta Gestrich,
  • Christian Bruch,
  • Eberhard Grube,
  • Marc M. Vorpahl,
  • Jens-Uwe Röhnisch,
  • Christopher Reithmann,
  • Sebastian Kufner,
  • Ulrich Tebbe,
  • Stephan Gielen,
  • Christoph Axthelm,
  • Steffen Schön,
  • Jan Bernd Böckenförde

摘要

Background

Cardiogenic shock (CS) remains the leading cause of death in acute myocardial infarction (AMI). Sex-related disparities in AMI-CS have been reported, but findings vary across cohorts.

Objectives

The authors examined the clinical characteristics and in-hospital outcomes of consecutive women and men with AMI-CS.

Methods

The ALKK coronary angiography (CAG) registry prospectively enrolled consecutive CAG and percutaneous coronary interventions (PCI) across 51 participating hospitals in Germany.

Results

Between January 2009 and December 2020, a total of 4204 patients undergoing CAG for suspected AMI-CS were included. Women (30.5%, n = 1281) were on average 6 years older (74.3 vs. 68.0 years, P < .001) and had more comorbidities. They less frequently had significant coronary artery disease (CAD), 82.3% vs. 90.3%, P < .001. No significant sex differences in the recommendation for revascularization (PCI or CABG) among patients with significant CAD after adjustment for age (92.4% vs. 91.3%, adjusted OR: 1.3; 95% CI: 0.99–1.72) were observed. There were no sex differences in hospital mortality after adjustment for age, particularly in the PCI group, age-adjusted OR: 1.06; 95% CI: 0.90–1.25, multivariable adjusted OR: 1.09; 95% CI: 0.92–1.28.

Conclusions

In this large, contemporary registry, women with early CAG for AMI-CS were older than men and had more comorbidities. Significant CAD was less frequently diagnosed in women with suspected AMI-CS. After adjustment for age, there were neither sex differences in revascularization strategies nor in hospital mortality after PCI for AMI-CS. These results question previous reports about undertreatment and higher mortality of AMI-CS in women.

Graphical Abstract