Abstract 12328: Impact of Female Sex on Cardiogenic Shock Outcomes - A Cardiogenic Shock Working Group Report

Abstract

Introduction: Studies reporting cardiogenic shock (CS) outcomes in women are scarce. Hypothesis: Among patients with CS complicating acute myocardial infarction (AMI-CS) and heart failure (HF-CS), women have worse survival at discharge and more vascular complications than men. Methods: We analyzed 5,083 CS patients in the Cardiogenic Shock Working Group. Propensity score matching (PSM) was performed using baseline characteristics. Logistic regression was performed for log odds of survival. Results: Among 5,083 patients, 1,522 were women (30%) with a mean age of 66.5±13.2 years. There were 30% women and 29.1% men with AMI-CS (p=0.03). More women presented with de novo HF-CS compared to men (26.2% vs. 19.3%, p<0.001). Before PSM, differences in baseline characteristics and sex-specific outcomes were seen in the HF-CS cohort, with worse survival at discharge (69.9% vs. 74.4%, p=0.009) (Figure A) and higher maximum SCAI stage E (26% vs. 21%, p=0.04) in women than men (Figure B). Women were less likely to receive pulmonary artery catheters (52.9% vs. 54.6%, p<0.001), heart transplant (6.5% vs. 10.3%, p<0.001) or left ventricular assist device (7.8% vs. 10%, p=0.01). Differences in AMI-CS cohort were less discrepant. Regardless of CS etiology, women had more vascular complications (8.8% vs. 5.7%, p<0.001), bleeding (7.1% vs. 5.2%, p=0.01), and limb ischemia (6.8% vs. 4.5%, p=0.001) (Figure C). More vascular complications persisted in women after PSM (10.4% women vs. 7.4% men, p=0.06). Conclusions: Women with HF-CS had worse outcomes and more vascular complications than men with HF-CS. More studies are needed to identify barriers to advanced therapies, decrease complications and improve outcomes of women with CS.