Abstract
Introduction: Cardiogenic shock (CS) is a state of end organ hypo-perfusion due to primary pump failure, 80% of which is due to acute myocardial infarction (AMI). Among patients with AMI-CS, women as well as black and Hispanic males have been found to have worse clinical outcomes with persistent sex disparities after receiving mechanical circulatory support (MCS). However similar differences in outcomes of CS in non-AMI patients with MCS are unknown. Methods: National Inpatient Sample database from years 2015 to 2018 was queried to identify patients admitted with non-AMI-CS. Gender and racial differences in baseline demographics and in-hospital outcomes were compared in patients who received VA-ECMO with or without LV unloading devices. Statistical significance was assigned at p<0.05. Results: 178,605 patients met the criteria for non-AMI-CS out of which 2,190 (1.23%) patients received VA-ECMO alone, 965 (0.54%) received VA-ECMO plus Intra-aortic balloon pump (IABP) and 414 (0.23%) received VA-ECMO plus Impella. Gender and racial distribution of each cohort is shown in figure 1. On multivariate analysis, the in-hospital mortality rates in patients on VA-ECMO only or VA-ECMO plus Impella were non significantly higher for females as compared to males (OR: 1.29 (0.88-1.89), p=0.18), (OR: 1.97 (0.27-14.64), p=0.51) respectively, whereas in patients with VA-ECMO plus IABP they were non-significantly lower than males (OR: 0.74 (0.28-1.99), p=0.55). Furthermore, the in-hospital mortality was non significantly lower in African Americans when compared to Caucasians among patients on VA-ECMO with or without LV unloading devices. Conclusions: In patients admitted with non-AMI-CS requiring VA-ECMO with or without LV unloading devices no statistically significant gender or race-based differences occur in mortality outcomes.
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