Volume 82, August 2024, 154785Author links open overlay panel, , , , , , , , , , , , , , , , , , , …AbstractBackground

Cardiogenic shock (CS) is the most severe form of acute heart failure. Discrepancies have been reported between sexes regarding delays, pathways and invasive strategies in CS complicating acute myocardial infarction. However, effect of sex on the prognosis of unselected CS remains controversial.

Objectives

The aim was to analyze the impact of sex on aetiology, management and prognosis of CS.

Methods

The FRENSHOCK registry included all CS admitted in 49 French Intensive Care Units (ICU) and Intensive Cardiac Care Units (ICCU) between April and October 2016.

Results

Among the 772 CS patients included, 220 were women (28.5%). Women were older, less smokers, with less history of ischemic cardiac disease (20.5% vs 33.6%) than men. At admission, women presented less cardiac arrest (5.5 vs 12.2%), less mottling (32.5 vs 41.4%) and higher LVEF (30 ± 14 vs 25 ± 13%). Women were more often managed via emergency department while men were directly admitted at ICU/ICCU. Ischemia was the most frequent trigger irrespective of sex (36.4% in women vs 38.2%) but women had less coronary angiogram and PCI (45.9% vs 54% and 24.1 vs 31.3%, respectively). We found no major difference in medication and organ support. Thirty-day mortality (26.4 vs 26.5%), transplant or permanent assist device were similar in both sexes.

Conclusion

Despite some more favorable parameters in initial presentation and no significant difference in medication and support, women shared similar poor prognosis than men. Further analysis is required to cover the lasting gap in knowledge regarding sex specificities to distinguish between differences and inequalities. NCT02703038

Section snippetsBackground

Cardiogenic shock (CS) is characterized by its diversity in terms of etiologies and severity, and prognosis seems to be linked to aetiology [1]. Impact of sex on CS prognosis remains controversial [[2], [3], [4], [5]]. Addressing sex disparity appears crucial as differences in the impact of risk factors, the role of specific risk factors and biological specificities have been reported in heart failure pathophysiology [6]. Likewise, such differences have been acknowledged in ischemic cardiac

Patient population

This study is post-hoc cohort analysis of the prospective multicenter observational FRENSHOCK registry, conducted in metropolitan France between April and October 2016 in 49 Intensive Care Units (ICU) and Intensive Cardiac Care Units (ICCU) (NCT02703038), whose primary objective was to describe the characteristics, management and outcome of patients with CS [14,15].

All adult patients (≥18 years old) with CS were prospectively included if they met at least one criterion of each of the following

Baseline characteristics

Among the 772 CS patients included in 49 centres (Supplemental Fig. 1), 220 were women (28.5%). Table 1 reported the clinical characteristics. Women were older (68 ± 16 vs 65 ± 14, p = 0.03), more often housekeeping (4.1 vs 1.3%, p = 0.001) or retired (73.6 vs 64%, p = 0.001). Cardiovascular risk factors were similar between sex but men were twice likely current smokers (32.2% vs 16.5%, p < 0.001). Women reported less previous ischemic cardiac disease (20.5% vs 33.6%, p < 0.001) and less

Discussion

This large national registry of unselected patients with CS highlights that sex differences in CS are related to clinical presentation and care pathway rather than management or outcomes. The main result of the FRENSHOCK Sex analysis is that despite some initial more favorable parameters in initial presentation in women including greater LVEF and less cardiac arrest, CS severity defined by use of vasopressive drugs, presence of organ failure and lactates level, and prognosis remain as poor in

Conclusion

In this large unselected cohort of CS from all etiologies, women shared similar poor prognosis than men despite some more favorable parameters in initial presentation, less cardiac arrest, better LVEF and no significant difference in support and medication used, except for dobutamine use. These discrepancies deserve further analysis to cover the lasting gap in knowledge regarding sex specificities to distinguish between differences and inequalities.

Ethics approval and consent to participate

Written consent was obtained for all the patients. The data recorded and their handling and storage were reviewed and approved by the CCTIRS (French Health Research Data Processing Advisory Committee) (n°15.897) and the CNIL (French Data Protection Agency) (n° DR-2016-109).

Consent for publication

Not Applicable.

Availability of data and material

Proposals for data access will be considered by the Frenshock Steering Committee in accordance with the data access policy of the study sponsor (French Cardiology Society).

Funding

The study was sponsored by the Fédération Française de Cardiologie and was funded by unrestricted grants from Daiichi-Sankyo, Orion pharma and Maquet SAS.

Authors' contributions

All authors had full access to all the data and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: SMS, ACM, FB, CHB and CD. Acquisition, analysis, or interpretation of data: SMS, ACM, FB, CHB, EP and CD. Drafting of the manuscript: SMS, ACM, FB, CHB and CD. Critical revision of the manuscript for important intellectual content: SMS, ACM, FB, CHB, NA, EP, VB and CD. Statistical analysis and data verification: VB, EP and CD. Obtained

Declaration of competing interest

Manzo-Silberman S has received consulting fees from Bayer, Organon, Exeltis, lecture fees from Bayer, BMS, Exeltis and Organon, has served in the adjudication board for a study for Biotronik. Martin AC has received consulting fees from Alliance BMS-Pfizer, Bayer, grants from Alliance BMS-Pfizer, lecture fees from Alliance BMS-Pfizer, Abbott, Bayer, Novartis. Boissier.F has received travel and accomodation fees from AOP Orphan. Leurent.G reports proctoring activity, lecture and consultant fees

Acknowledgements

FRENSHOCK is a registry of the French Society of Cardiology, managed by its Emergency and Acute Cardiovascular Care Working Group. Our thanks go out to all the devoted personnel of Société Française de Cardiologie who actively participate in the upkeep of the registry especially N. Naccache, E. Drouet and Tessa Bergot. The authors are deeply indebted to all the physicians who took care of the patients at the participating institutions (complete list of investigators in supplemental material).

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