Temporal trends in clinical characteristics and management according to sex in patients with cardiogenic shock after acute myocardial infarction: The FAST-MI programme

Background. - Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) occurs more frequently in women, but little is known about its potential specificities according to sex. Aims. - To analyse the incidence, management and 1-year mortality of CS according to sex using the FAST-MI programme. Methods. - The FAST-MI programme consists of four nationwide French surveys carried out 5 years apart from 1995 to 2010, including consecutive patients with AMI over a 1-month period, and with a 1-year follow-up. Results. - Among the 10,610 patients included in the surveys, the incidence of CS was 4.8% in men and 8.2% in women (P < 0.001). Absolute incidence of CS decreased from 1995 to 2010 in both sexes. Mean age in patients with CS tended to decrease in men (from 72 +/- 12 to 69 +/- 13 years) and to increase in women (from 78 +/- 10 to 80 +/- 9 years):One-year mortality decreased significantly in men (from 70% in 1995 to 48% in 2010) and in women (from 81% to 54%). Using Cox multivariable analysis, female sex was not an independent correlate of 1-year mortality [hazard ratio (HR): 0.98, 95% confidence interval (CI): 0.78-1.22]. Early use of percutaneous coronary intervention was, however, an independent predictor of 1-year survival in women (HR: 0.55, 95% CI: 0.37-0.81), but showed only a non-significant trend in men (HR: 0.85, 95% CI: 0.61-1.19). Conclusions. - The incidence of CS-AMI has decreased in both men and women, but remains higher in women. One-year mortality has significantly decreased `for both men and women, and the rote of early percutaneous coronary intervention as a potential mediator of decreased mortality seems greater in women than in men. (C) 2018 Elsevier Masson SAS. All rights reserved.