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. 2023 Jun 27;59(7):1208.
doi: 10.3390/medicina59071208.

Sex-Related Differences in Short-Term Prognosis in Patients with Acute Myocardial Infarction-Related Cardiogenic Shock Receiving Impella Support in Japan: From the J-PVAD Registry

Makiko Nakamura  1 , Teruhiko Imamura  1 , Hiroshi Ueno  1 , Koichiro Kinugawa  1 , J-Pvad Investigators  1
Affiliations

Sex-Related Differences in Short-Term Prognosis in Patients with Acute Myocardial Infarction-Related Cardiogenic Shock Receiving Impella Support in Japan: From the J-PVAD Registry

Makiko Nakamura et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Sex-specific outcome in patients with acute myocardial infarction-related cardiogenic shock (AMI-CS) receiving temporary mechanical circulatory support remains controversial. Materials and Methods: Patients with AMI-CS who received Impella support were prospectively enrolled in the Japanese registry for Percutaneous Ventricular Assist Device. Patients enrolled between January 2021 and December 2022 were considered to be eligible. Patients with out-of-hospital cardiac arrest and those without revascularization were excluded. The sex disparity in the 30-day survival after the initiation of Impella support was evaluated. Results: A total of 924 patients (median age 73 years; 21% female) were included. Female patients were older and had a smaller physiques than male patients (p < 0.05 for both). Female sex was significantly associated with a higher 30-day mortality after adjustment for four other potential confounders with a hazard ratio of 1.365 (95% confidence interval 1.026-1.816, p = 0.0324). In the female cohort, patients who received Impella prior to revascularization (N = 138) had a greater survival rate compared to those who received Impella after revascularization (68.1% versus 44.8%, p = 0.0015). Conclusions: Among the patients with AMI-CS who received Impella support and underwent revascularization, female sex was independently associated with a lower 30-day survival. For female patients, early initiation of Impella support prior to revascularization may improve their clinical outcomes.

Keywords: acute heart failure; gender difference; mechanical circulatory support; unloading.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient population of AMI-CS was shown (A). Patients with AMI-CS who received revascularization during index hospitalization were included in this study (B). AMI-CS, Acute myocardial infarction-related cardiogenic shock; AMI, acute myocardial infarction.
Figure 2
Figure 2
Comparison of 30-day survival between female and male patients after initiation of Impella support in AMI-CS was shown. AMI-CS, Acute myocardial infarction-related cardiogenic shock.
Figure 3
Figure 3
Comparison of 30-day survival between female and male patients with or without Impella-supported revascularization in AMI-CS was shown. AMI-CS, Acute myocardial infarction-related cardiogenic shock.
See this image and copyright information in PMC

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