Comparing the Outcomes of Cardiogenic Shock After Myocardial Infarction in Women Across Different Age Groups.

BACKGROUND

Cardiogenic shock (CS) complicating myocardial infarction (MI) is associated with high morbidity and mortality, with age- and sex-specific differences in presentation and outcomes. Female patients, often underrepresented in cardiovascular research, exhibit distinct clinical profiles and treatment patterns. However, age-stratified outcomes among women with post-MI CS remain insufficiently described.

AIM: This study aimed to compare the outcomes of post-MI CS between female patients in two distinct age groups: 45-55 and 56-75 years.

METHODS

We conducted a retrospective cohort study using the TriNetX Research Network, including deidentified electronic health records from 102 healthcare organizations between January 1, 2017, and January 1, 2023. Female patients aged 45-55 or 56-75 years with both acute MI (International Classification of Diseases, 10th Revision, ICD-10: I21) and CS (ICD-10: R57.0) were identified. Two cohorts were generated and matched 1:1 using propensity scores for demographics and comorbidities, resulting in 1,100 patients per group. Outcomes assessed included all-cause mortality, major adverse cardiac events (MACE), arrhythmias, atrial fibrillation (Afib), cardiac device procedures/complications, and emergency readmissions over a three-year follow-up. Outcomes were compared using Kaplan-Meier analysis and Cox proportional hazards models.

RESULTS

Older women (56-75 years) had significantly higher three-year mortality compared to the younger cohort (41.2% vs. 36.2%, p = 0.016), as well as increased incidence of Afib (26.5% vs. 22.7%, p = 0.038). Rates of MACE and other arrhythmias were similar between the groups. Emergency readmissions were more common in younger women (33.7% vs. 29.3%, p = 0.025), while device-related procedures showed low event rates and group-specific trends. Absolute differences in outcomes were modest.

CONCLUSIONS

Age-related differences exist among female patients with post-MI CS. Older women face higher mortality and Afib risk, while younger women experience more frequent emergency readmissions. These findings highlight the need for age-specific postdischarge strategies, but must be interpreted cautiously given the study's retrospective design, reliance on administrative coding, and lack of granular clinical data. Further prospective research is needed to elucidate the mechanisms and inform tailored interventions for women with CS following MI.