Sex Differences in Management, Time to Intervention, and In-Hospital Mortality of Acute Myocardial Infarction and Non-Myocardial Infarction Related Cardiogenic Shock.

Background/

Objectives

Cardiogenic shock (CS) is associated with high mortality, particularly in women. With early intervention being a cornerstone of CS management, this study aims to explore whether sex differences exist in the utilization of critical interventions, timing of treatment, and in-hospital mortality for patients with acute myocardial infarction (AMI) and non-AMI-CS.

Methods

For this retrospective cohort study, we queried the National Inpatient Sample (years 2016-2021) for CS-related hospitalizations. We assessed sex differences in utilization, timing, and outcomes of CS interventions, adjusting for demographics, comorbidities, and prior cardiac interventions via multivariate logistic regressions.

Results

Of 1,052,360 weighted CS hospitalizations, 60% were for non-AMI-CS and 40% were for AMI-CS. Women with CS had lower rates of all interventions. For AMI-CS, women had higher likelihoods of in-hospital mortality after revascularization (adjusted odds ratio 1.15 [95% confidence interval 1.09-1.22]), mechanical circulatory support (MCS) (1.15 [1.08-1.22]), and right heart catheterization (RHC) (1.10 [1.02-1.19]) (all p < 0.001). Similar trends were seen in the non-AMI-CS group. Women with AMI-CS were less likely to receive early (within 24 h of admission) revascularization (0.93 [0.89-0.96]), MCS (0.76 [0.73-0.80]), or RHC (0.89 [0.84-0.95]); women with non-AMI-CS were less likely to receive early revascularization (0.78 [0.73-0.84]) or RHC (0.83 [0.79-0.88]) (all p < 0.001). Regardless of CS type, in-hospital mortality was not significantly different between men and women receiving early MCS or revascularization.

Conclusions

Sex disparities in the frequency of treatment of CS persist on a national scale, with women being more likely to die following treatment and less likely to receive early treatment. However, in-hospital mortality does not differ significantly when men and women are treated equally within 24 h of admission, suggesting that early intervention should be made a priority to mitigate sex-based differences in CS outcomes.