Sex-related differences in patients with acute myocardial infarction complicated by cardiogenic shock: A systematic review and meta-analysis.

Mubashar Karamat, Bansari Patel, Resha Khanal, Mohammad Hamza, Sadaf Fakhra, Ritu Yadav, Neel Navinkumar Patel, Junaid Mir, Nomesh Kumar, Khaled M Harmouch, Masooma Naseem, Yasemin Bahar, Maria Riasat, Harshith Thyagaturu, Yasar Sattar, M Chadi Alraies
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Abstract

Background: This review aims to analyze sex-related differences in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS).

Methods: 10 studies were retrieved from PubMed and Embase comparing outcomes between men and women admitted with AMI complicated by CS. Pooled log odds ratios (OR) were calculated for binary outcomes using the Mantel-Haenszel method, and Hedges' g with the inverse-variance method was used for continuous outcomes.

Results: The primary endpoints were in-hospital mortality and 30-day mortality. The secondary endpoints were reinfarction rate, length of hospital stay (LOS), requirement of renal replacement therapy (RRT), and stroke (ischemic and hemorrhagic). Males exhibited a lower risk of in-hospital mortality (OR 0.77, 95 % CI 0.69-0.85, I2 = 97 %, p < 0.0001), 30-day mortality (OR 0.69, 95 % CI: 0.61-0.78, I² = 0 %, p < 0.0001) and stroke (OR 0.91, 95 % CI 0.87-0.95, I2 = 36 %, p < 0.0001) compared to females. In contrast, males were more likely to require renal replacement therapy (RRT) (OR 1.27, 95 % CI 1.09-1.48, I2 = 69 % p = 0.0017). However, there were no statistically significant differences between females and males in terms of reinfarction rate (OR 0.88, 95 % CI 0.66-1.18, I2 = 56 %, p = 0.3936) or length of hospital stay during hospitalization (Hedges's g 0.35 days, 95 % CI -0.38-1.07, I2 = 100 %, p = 0.34).

Conclusion: Females with AMI and CS have higher in-hospital mortality, 30-day mortality, and stroke risk than men. Men are more likely to require RRT. Further research is needed to understand underlying mechanisms and improve outcomes for both genders.

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急性心肌梗死并发心源性休克患者的性别差异:系统回顾和荟萃分析
背景:本综述旨在分析急性心肌梗死(AMI)合并心源性休克(CS)患者的性别差异。方法:从PubMed和Embase检索10项研究,比较AMI合并CS的男性和女性的结局。二元结果采用Mantel-Haenszel方法计算合并对数比值比(OR),连续结果采用Hedges’g和反方差法计算。结果:主要终点为住院死亡率和30天死亡率。次要终点是再梗死率、住院时间(LOS)、肾脏替代治疗(RRT)的需求和卒中(缺血性和出血性)。与女性相比,男性的住院死亡率(OR 0.77, 95% CI 0.69-0.85, I2 = 97%,p < 0.0001)、30天死亡率(OR 0.69, 95% CI: 0.61-0.78, I2 = 0%,p < 0.0001)和中风(OR 0.91, 95% CI 0.87-0.95, I2 = 36%,p < 0.0001)风险较低。相比之下,男性更有可能需要肾脏替代治疗(RRT) (OR 1.27, 95% CI 1.09-1.48, I2 = 69% p = 0.0017)。然而,在再梗死率(OR 0.88, 95% CI 0.66-1.18, I2 = 56%,p = 0.3936)或住院时间(Hedges's g 0.35天,95% CI -0.38-1.07, I2 = 100%,p = 0.34)方面,男女之间无统计学差异。结论:AMI和CS女性的住院死亡率、30天死亡率和卒中风险均高于男性。男性更有可能需要RRT。需要进一步的研究来了解潜在的机制并改善两性的结果。
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