{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T01:15:49Z","timestamp":1782177349904,"version":"3.54.5"},"reference-count":30,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2021,3,7]],"date-time":"2021-03-07T00:00:00Z","timestamp":1615075200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Eur J Clin Investigation"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>There are limited data on sex\u2010specific outcomes and management of cardiogenic shock complicating ST\u2010segment elevation myocardial infarction (CS\u2010STEMI). We investigated whether any sex bias exists in the admission to revascularization capable hospitals (RCH) or intensive cardiac care units (ICCU) and its impact on in\u2010hospital mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used the Spanish National Health System Minimum Basic Data from 2003 to 2015 to identify patients with CS\u2010STEMI. The primary outcome was sex differences in in\u2010hospital mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 340\u00a0490 STEMI patients, 20\u00a0262 (6%) had CS and 29.2% were female. CS incidence was higher in women than in men (7.9% vs 5.1%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.001). Women were older and had more hypertension and diabetes, and were less often admitted to RCH than men (from 58.7% in 2003 to 79.6% in 2015; and from 61.9% in 2003 to 85.3% in 2015; respectively, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.01), and to ICCU centres (25.7% vs 29.2%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.001). Adjusted mortality was higher in women than men over time (from 79.5\u00a0\u00b1\u00a04.3% to 65.8\u00a0\u00b1\u00a06.5%; and from 67.8\u00a0\u00b1\u00a06% to 58.1\u00a0\u00b1\u00a06.5%; respectively, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001). ICCU availability was associated with higher use of Percutaneous coronary intervention (PCI) in women (46.8% to 67.2%; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001) but was even higher in men (54.8% to 77.4%; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001). In ICCU centres, adjusted mortality rates decreased in both sexes, but lower in women (from 74.9\u00a0\u00b1\u00a05.4% to 66.3\u00a0\u00b1\u00a06.6%) than in men (from 67.8\u00a0\u00b1\u00a06.0% to 58.1\u00a0\u00b1\u00a06.5%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001). Female sex was an independent predictor of mortality (OR 1.18 95% CI 1.10\u20101.27, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Women with CS\u2010STEMI were less referred to tertiary\u2010care centres and had a higher adjusted in\u2010hospital mortality than men.<\/jats:p><\/jats:sec>","DOI":"10.1111\/eci.13526","type":"journal-article","created":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T17:36:26Z","timestamp":1614101786000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["Sex bias in admission to tertiary\u2010care centres for acute myocardial infarction and cardiogenic shock"],"prefix":"10.1111","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3939-5559","authenticated-orcid":false,"given":"Antonia","family":"Sambola","sequence":"first","affiliation":[{"name":"Department of Cardiology Hospital Universitari Vall d'Hebron Universitat Aut\u00f2noma Barcelona Spain"},{"name":"Research Institute Hospital Universitari Vall d'Hebron Universitat Aut\u00f2noma Barcelona Spain"},{"name":"CIBER de enfermedades CardioVasculares (CIBER\u2010CV) Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco Javier","family":"Elola","sequence":"additional","affiliation":[{"name":"Foundation Institute for Healthcare Improvement Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Buera","sequence":"additional","affiliation":[{"name":"Department of Cardiology Hospital Universitari Vall d'Hebron Universitat Aut\u00f2noma Barcelona Spain"},{"name":"Research Institute Hospital Universitari Vall d'Hebron Universitat Aut\u00f2noma Barcelona Spain"},{"name":"CIBER de enfermedades CardioVasculares (CIBER\u2010CV) Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Foundation Institute for Healthcare Improvement Madrid Spain"},{"name":"Department of Preventive Medicine Hospital Cl\u00ednico Universitario San Carlos Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Luis","family":"Bernal","sequence":"additional","affiliation":[{"name":"Foundation Institute for Healthcare Improvement Madrid Spain"},{"name":"Universidad Complutense de Madrid Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Ariza","sequence":"additional","affiliation":[{"name":"CIBER de enfermedades CardioVasculares (CIBER\u2010CV) Barcelona Spain"},{"name":"Heart Diseases Institute Hospital Universitario de Bellvitge \u2013IDIBELL L'Hospitalet de Llobregat Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph","family":"Brindis","sequence":"additional","affiliation":[{"name":"Department of Medicine &amp; The Philip R. Lee Institute for Health Policy Studies University of California San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00e9ctor","family":"Bueno","sequence":"additional","affiliation":[{"name":"CIBER de enfermedades CardioVasculares (CIBER\u2010CV) Barcelona Spain"},{"name":"Management Control Department Hospital Universitario 12 de Octubre Madrid Spain"},{"name":"Centro Nacional de Investigaciones Cardiovasculares (CNIC) Madrid Spain"},{"name":"Department of Cardiology Hospital Universitario 12 de Octubre Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Rodr\u00edguez\u2010Padial","sequence":"additional","affiliation":[{"name":"Department of Cardiology Hospital Virgen de la Salud Toledo Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Mar\u00edn","sequence":"additional","affiliation":[{"name":"Hospital Universitario Virgen de la Arrixaca El Palmar Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Antonio","family":"Barrab\u00e9s","sequence":"additional","affiliation":[{"name":"Department of Cardiology Hospital Universitari Vall d'Hebron Universitat Aut\u00f2noma Barcelona Spain"},{"name":"Research Institute Hospital Universitari Vall d'Hebron Universitat Aut\u00f2noma Barcelona Spain"},{"name":"CIBER de enfermedades CardioVasculares (CIBER\u2010CV) Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renee","family":"Hsia","sequence":"additional","affiliation":[{"name":"Health Policy Studies in the Department of Emergency Medicine at University of California San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Anguita","sequence":"additional","affiliation":[{"name":"Department of Cardiology Hospital Universitario Reina Sof\u00eda de Cordoba C\u00f3rdoba Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,3,7]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.613596"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199908263410901"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000525"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx393"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.814947"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs264"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.114.001462"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/2048872619883997"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.113.000590"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2012.10.007"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2013.04.038"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(01)01581-9"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-014-0767-2"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.10573"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.0514"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.110.959262"},{"key":"e_1_2_9_18_1","first-page":"546","article-title":"Trends in cardiogenic shock management and prognostic impact of type of treating center","volume":"73","author":"S\u00e1nchez\u2010Salado JC","year":"2019","journal-title":"Rev Esp Cardiol (Engl Ed)"},{"key":"e_1_2_9_19_1","first-page":"30361","article-title":"Clinical and administrative data on the research of acute coronary syndrome in Spain. 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