OR06-4
Gender Disparities in Temporary Mechanical Circulatory Support in Patients with Acute Myocardial Infarction and Cardiogenic Shock
Nadhem Abdallah, Hennepin County Medical Center, minneapolis, MN
Nadhem Abdallah1, Abdilahi Mohamoud, MBBS2, Kevin G Buda, MD2 and Mariam Abdallah3, (1)Hennepin County Medical Center, minneapolis, MN, (2)Hennepin Healthcare, Minneapolis, MN, (3)University of Saskatchewan, saskatoon, SK, Canada
Keywords: Acute Coronary Syndromes (ACS), Cardiogenic Shock, Hemodynamic Support and Women's Health
Background
Cardiovascular disease is the leading cause of mortality in women, both in the United States and globally. Despite declining cardiovascular disease-related mortality since 1984, the annual mortality rate for women remains higher than that for men. While sex-specific differences in the pathophysiology, presentation, and outcomes of acute myocardial infarction (AMI) and cardiogenic shock (CS) have been identified, there is a paucity of data on the impact of gender on utilization and outcomes of temporary mechanical circulatory support in patients with AMI-CS. Methods
We queried the 2016-2019 National Inpatient Sample (NIS) database, identifying cases of acute myocardial infarction and cardiogenic shock. Men were utilized as our control group, while women comprised our cohort. The primary outcome was the occurrence of temporary mechanical circulatory support, specifically ventricular assist devices (LVADs), Impella devices, and intra-aortic balloon pumps. Secondary outcomes included in-hospital mortality and length of stay. Multivariate linear and logistic regression models were employed to adjust for confounders. Results
Of patients with a primary diagnosis of acute myocardial infarction (N = 2,622,939), 37.7% were women. Of the women admitted for acute myocardial infarction, 71.8% were white, 67.8% were Medicare patients, 37% were tobacco users, and 12.4% had a history of ischemic heart disease. Women with AMI and CS had higher inpatient mortality (4.3% vs. 5.0%, adjusted OR 1.06, p<0.05) than men. Women were less likely to receive temporary mechanical circulatory support than men (3.9% vs. 5.8% and p<0.05), including ventricular assist device (2.3% vs. 2.9% and p<0.05), IABP (3.0% vs. 4.4% and p <0.05) and Impella (1.0% vs. 1.5% and p <0.05). Moreover, women with AMI and CS were found to have longer hospitalization length of stay when compared to hospitalized men with AMI-CS (4.3 vs 4.4 days and p<0.05). Conclusions
Women admitted for acute myocardial infarction complicated by cardiogenic shock were less likely to receive temporary mechanical circulatory support despite being a sicker cohort with longer lengths of stay and higher in-hospital mortality.