Sex-Related Differences in Patient Characteristics, Hemodynamics, and Outcomes of Cardiogenic Shock: INOVA-SHOCK Registry.

ABSTRACT

Background: Little is known about sex-related differences in outcomes of patients with cardiogenic shock (CS) treated within a standardized team-based approach (STBA). Methods: We evaluated 520 consecutive patients (151 women and 369 men) with CS due to acute myocardial infarction (AMI) and heart failure (HF) in a single-center registry (January 2017-December 2019) and examined outcomes according to sex and CS phenotype. The primary outcome was in-hospital mortality. Secondary outcomes included major adverse cardiac events, 30-day mortality, major bleeding, vascular complications, and stroke. Results: Women with AMI-CS had higher baseline acuity (CardShock score female [F] 5.5 vs male [M] 4.0; P = .04). Women with HF-CS more often presented with cardiac arrest (F 12.4% vs M 2.4%; P< .01) and had higher rates of vasopressor use (F 70.8% vs M 58.0%; P = .04) and mechanical circulatory support (F 46.1% vs M 32.5%; P = .04). There were no sex-related differences in in-hospital mortality for AMI-CS (F 45.2% vs M 36.9%; P = .28) and HF-CS (F 28.1% vs M 24.5%; P = .56). Women with HF-CS experienced higher rates of major bleeding (F 25.8% vs M 13.7%; P = .02) and vascular complications (F 15.7% vs M 6.1%; P = .01). However, female sex was not an independent predictor of these complications. No sex differences in survival were noted at 1 year. Conclusions: Within an STBA, although women with AMI-CS and HF-CS presented with higher acuity, they experienced similar in-hospital mortality, major adverse cardiac events, 30-day mortality, stroke, and 30-day readmissions as men. Further research is needed to better understand the extent to which historical differences in CS outcomes can be mitigated by an STBA.