Sex Differences in Non-Acute Myocardial Infarction Cardiogenic Shock: Insights from the Northwell-Shock Registry
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Background
Previous studies had explored the role of patients’ sex in defining clinical presentation, management, and outcomes among patients with acute myocardial infarction (AMI) related cardiogenic shock (CS). However, the effect of sex among patients with non-acute myocardial infarction related CS (nonAMI-CS) is less well defined.
Method
Adult patients treated for CS (International Classification of Diseases, Tenth Revision, [ICD-10] code R57.0) between 2016 and 2022 across eleven hospitals within our health system, all utilizing a shared electronic medical record, were included. CS etiologies were defined as AMI, nonAMI and others. For nonAMI-CS patients, stratification by sex was performed to compare the incidence of specific etiologies, baseline characteristics, management and outcomes between men and women. Comparisons were conducted using t-tests, Wilcoxon rank-sum tests or chi-square tests. Logistic regression models were developed to examine the effect of sex on in-hospital mortality, management strategies, and mortality predictors.
Result
2,256 patients admitted for nonAMI-CS were identified. Women comprised 36% of the study cohort and were older and had more medical comorbidities. There was no significant difference in presenting CS severity as measured by Society for Cardiovascular Angiography and Interventions (SCAI) stages, APACHE scores or in-hospital mortality. There were significant differences in the specific etiologies of nonAMI-CS, where women had more valvular cardiogenic shock. Women received fewer invasive interventions including pulmonary artery catheter (PAC) and intra-aortic balloon pump (IABP) when compared to men but similar rates of Impella and venoarterial extracorporeal membrane oxygenation (VA-ECMO). Lastly, women were more likely to be discharged to skilled nursing facilities while men more likely to home.
Conclusion
Significant sex-specific differences exist in nonAMI-CS including specific etiologies, management strategies, and factors associated with mortality. Despite older age, more comorbidities and lower rates of invasive management procedures, women had similar survival to men but higher need for skilled facilities upon discharge.
