Women with STEMI complicated by cardiogenic shock experienced persistently higher in-hospital mortality (aOR 1.06; 95% CI 1.02-1.10) and lower mechanical circulatory support utilization than men.
Cohort (n=292,230)
Yes
Do sex-based disparities in in-hospital mortality and mechanical circulatory support utilization persist over time in patients with STEMI complicated by cardiogenic shock?
Despite overall improvements in STEMI-CS outcomes from 2008 to 2022, women continue to experience higher mortality and lower utilization of mechanical circulatory support compared to men.
Effect estimate: aOR 1.06 (95% CI 1.02-1.10)
Abstract Rationale Sex-based disparities persist in STEMI complicated by cardiogenic shock (CS), which carries mortality rates exceeding 30%. However, whether these disparities have changed as therapies evolved, including widespread adoption of percutaneous left ventricular assist devices (pLVAD), remains unknown. Using the National Inpatient Sample (2008-2022), this study examined temporal trends in sex-based disparities in STEMI-CS management and outcomes. Methods A retrospective cohort of STEMI complicated by CS was identified from the National Inpatient Sample (2008-2022), with analysis of temporal trends in in-hospital mortality and mechanical circulatory support (MCS) utilization. MCS utilization encompassed intra-aortic balloon pump, pLVAD, and extracorporeal membrane oxygenation. Survey-weighted multivariable logistic regression adjusted for demographics, STEMI location, comorbidities, and hospital characteristics. Temporal trends were assessed using sex-by-year interaction terms within logistic models to evaluate changes in disparities over time. Secondary analyses examined sex differences in device selection among MCS recipients. Results Of 2,422,498 STEMI hospitalizations, 292,230 (12.1%) developed CS (65.2% male, 34.8% female, mean age 67 years). Overall adjusted mortality improved from 34.3% to 28.8% (P-trend0.01) while MCS utilization declined from 54.7% to 45.0% (P-trend0.01) (Figure-1: Gender-stratified trends with 95% CIs (shaded). Propensity score matching confirmed persistent mortality disparity, matched OR 1.20, 95% CI 1.14-1.25. Sex × year interactions were non-significant (p 0.05), indicating stable disparities throughout the study period). However, sex-based differences persisted throughout the study period: women maintained higher mortality (adjusted odds ratio aOR 1.06, 95% confidence interval CI 1.02-1.10) and lower MCS utilization (aOR 0.71, 95% CI 0.68-0.73) compared to men (interaction P = 0.63 and P = 0.74, respectively). Among MCS-treated patients, 10.4% of women received pLVAD compared with 13.8% of men (aOR 0.78, 95% CI 0.71-0.84, P 0.01). Conclusions STEMI-CS outcomes improved significantly from 2008 to 2022, yet sex-based disparities in mortality and MCS utilization showed no temporal changes. In the management of STEMI-CS, women demonstrated differences at two points: they received MCS less frequently than men and were less likely to receive pLVAD when MCS was utilized. These persistent sex-based differences in STEMI-CS outcomes and management warrant further study to elucidate contributing factors and their effects. This abstract is funded by: none
Vemula et al. (Fri,) conducted a cohort in STEMI complicated by cardiogenic shock (n=292,230). Female sex vs. Male sex was evaluated on In-hospital mortality (aOR 1.06, 95% CI 1.02-1.10). Women with STEMI complicated by cardiogenic shock experienced persistently higher in-hospital mortality (aOR 1.06; 95% CI 1.02-1.10) and lower mechanical circulatory support utilization than men.