The impact of sex and its interaction with temporary mechanical circulatory support in cardiogenic shock patients.

BACKGROUND

Temporary mechanical circulatory support (tMCS) is increasingly used in managing cardiogenic shock, yet women remain underrepresented in studies evaluating its role. This analysis aims to clarify sex-specific in-hospital outcomes among cardiogenic shock patients treated with and without tMCS.

METHODS

We analyzed consecutive cardiogenic shock patients enrolled from January 2020 to November 2023 in the multicenter Altshock-2 Registry. The primary outcome was in-hospital mortality.

RESULTS

Among 692 patients [162 (23%) women, 530 (77%) men, mean age 65 (SD 14) years], cardiogenic shock was due to myocardial infarction in 50.1% and heart failure in 29.1%. Other causes were more common in females vs. males (30.5 vs. 17.8%, P value 0.03). At presentation, women had higher lactate levels [3.4 (1.7-7.3) vs. 2.6 (1.6-5.3) mmol/l, P value 0.03] and more frequent severe right ventricular dysfunction (61.8 vs. 49.6%, P value 0.02). tMCS was used in 445 (64.7%) patients without significant sex differences (P value 0.5). Intra-aortic balloon pump was the most used device (73% women vs. 82% men, P value 0.06), followed by extra corporeal membrane oxygenation (33.7 vs. 29.7%, P value 0.4) and Impella (18.8 vs. 23.5%, P value 0.3). A not-significant higher in-hospital mortality in women emerged in the overall (41.4 vs. 33.2%, P value 0.06) and in the tMCS (41.6 vs. 32%, P value 0.07) groups. At multivariate Cox regression analysis, female sex was associated with higher in-hospital mortality only in the tMCS group (adjusted hazard ratio 1.59; 95% confidence interval 1.05-2.39; P value 0.03). No differences emerged in terms of MCS-related complications (28 vs. 25%, P value 0.6).

CONCLUSION

Female sex is associated with a worse in-hospital survival among cardiogenic shock patients treated with tMCS. Future research should ensure adequate female representation to clarify underlying mechanisms.