No sex-based difference in cardiogenic shock: A post-hoc analysis of the DOREMI trial.

J Cardiol

CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada. Electronic address:

Published: October 2022

AI Article Synopsis

  • Cardiogenic shock (CS) is a serious condition linked to high rates of complications and death, and the DOREMI trial looked at how sex might affect outcomes in CS patients.
  • In a detailed analysis of 192 participants, researchers found that female patients had similar rates of severe outcomes as male patients, including death and need for mechanical support.
  • Ultimately, no significant differences were seen in the clinical outcomes between males and females in the study, regardless of the type of treatment (dobutamine or milrinone) used.

Article Abstract

Background: Cardiogenic shock (CS) is associated with significant morbidity and mortality; however, there are limited randomized data evaluating the association between sex and clinical outcomes in patients with CS. Patients with CS enrolled in the DObutamine compaREd with MIlrinone (DOREMI) trial were evaluated in this post-hoc analysis.

Methods: The primary outcome was a composite of all-cause mortality, resuscitated cardiac arrest, cardiac transplant or mechanical circulatory support, non-fatal myocardial infarction, transient ischemic attack or stroke, or initiation of renal replacement therapy. Secondary outcomes included the individual components of the primary outcome. We analyzed the primary and secondary outcomes using unadjusted relative risks and performed adjusted analysis for the primary outcome and all-cause mortality using the covariates mean arterial pressure <70 mmHg at inotrope initiation, age, and acute myocardial infarction CS.

Results: Among 192 participants in the DOREMI study, 70 patients (36 %) were female. The primary outcome occurred in 38 female patients (54 %) compared to 61 male patients (50 %) [adjusted relative risk (aRR) 1.23; 95 % CI 0.78-1.95, p = 0.97]. When stratified by inotrope, there was no difference in the primary outcome comparing females to males receiving dobutamine (RR 1.14; 95 % CI 0.79-1.65, p = 0.50) nor milrinone (RR 1.03; 95 % CI 0.68-1.57, p = 0.87). There was no difference in all-cause mortality comparing females to males (aRR 1.51; 95 % CI 0.78-2.94, p = 0.88). Additionally, there were no differences in any secondary outcomes between males and females (p > 0.05 for all endpoints).

Conclusion: In patients presenting with CS treated with milrinone or dobutamine, no differences in clinical outcomes were observed between males and females.

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Source
http://dx.doi.org/10.1016/j.jjcc.2022.06.001DOI Listing

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