D-111 | Temporal Trends in Cardiogenic Shock Management in Women: Insights From National Inpatient Sample 2016-2020

Background: Cardiogenic shock can complicate acute myocardial infarction (AMI-CS) and carries a high in-hospital mortality.Optimal revascularization-immediate percutaneous coronary intervention (PCI) versus early Coronary artery bypass grafting (CABG)-remains uncertain due to anatomical considerations, timing, and selection bias.National data may clarify patterns and outcomes.Methods: The National Inpatient Sample Database was queried from 2020 to 2022 for relevant ICD-10 diagnostic and procedural codes.Baseline characteristics and in-hospital outcomes were compared in patients with AMI-CS undergoing PCI vs CABG.Multivariate logistic regression was performed for select outcomes to adjust for differences in baseline characteristics.Results: We identified 16,328 hospitalizations for patients with AMI-CS, of which 12,591 underwent PCI and 3,737 underwent CABG.Mechanical circulatory support was used in both groups more than half of the time (50.1% in PCI and 52.6% in CABG) .Patients in the CABG group had a longer length of stay (15.4 days vs 7.8 days) and were more likely to require balloon pump assistance (45.8% vs 39%, P<.001), whereas patients in the PCI group were more likely to be assisted with microaxial flow pumps (23.5% vs 8.3%, P<.001).Conclusions: Observational data are risk-confounded by indication and timing; weights and sensitivity analyses help, but cannot eliminate bias.Decision for MCS should reflect anatomy, shock severity, and input from the heart team.Now post DANGER SHOCK trial in 2024, further studies should be done to confirm use of microaxial flow pumps over balloon pumps.Contemporary data will benchmark PCI versus CABG in AMI-CS across mortality, complications, and resource utilization; supporting individualized, time-sensitive care.