Impact of Female Sex on Cardiogenic Shock Outcomes: A Cardiogenic Shock Working Group Report.
Publication Title
JACC Heart Fail
Document Type
Article
Publication Date
12-1-2023
Keywords
oregon; portland; Male; Humans; Female; Middle Aged; Aged; Shock, Cardiogenic; Heart Failure; Myocardial Infarction; Coronary Angiography; Hospital Mortality; cards; cards publication
Abstract
BACKGROUND: Studies reporting cardiogenic shock (CS) outcomes in women are scarce.
OBJECTIVES: The authors compared survival at discharge among women vs men with CS complicating acute myocardial infarction (AMI-CS) and heart failure (HF-CS).
METHODS: The authors analyzed 5,083 CS patients in the Cardiogenic Shock Working Group. Propensity score matching (PSM) was performed with the use of baseline characteristics. Logistic regression was performed for log odds of survival.
RESULTS: Among 5,083 patients, 1,522 were women (30%), whose mean age was 61.8 ± 15.8 years. There were 30% women and 29.1% men with AMI-CS (P = 0.03). More women presented with de novo HF-CS compared with 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) and a higher rate of maximum Society for Cardiac Angiography and Interventions stage E (26% vs 21%; P = 0.04) in women than in men. Women were less likely to receive pulmonary artery catheterization (52.9% vs 54.6%; P < 0.001), heart transplantation (6.5% vs 10.3%; P < 0.001), or left ventricular assist device implantation (7.8% vs 10%; P = 0.01). 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). 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.
Clinical Institute
Cardiovascular (Heart)
Clinical Institute
Women & Children
Specialty/Research Institute
Cardiology
Specialty/Research Institute
Critical Care Medicine
DOI
10.1016/j.jchf.2023.09.025
