Sex-related outcomes during short-term mechanical circulatory support: A systematic review and meta-analysis of propensity-score matched studies

Background The association between sex and cardiovascular risk and different responses to heart failure therapies is well established. However, sex related outcomes of different types of short-term mechanical circulatory support (MCS) therapy remains controversial. Methods We performed a systematic review and meta-analysis of studies comparing outcomes of MCS between sexes. We restricted inclusion to propensity score matched studies to minimize the risk of confounding. We pooled binary and continuous outcomes with odds ratio (OR) and mean differences (MD), respectively, under a random effects model. Results We pooled 6 propensity score matched studies evaluating sex related outcomes during short-term MCS, with 18,720 patients, of whom 9442 (50.5%) were male and 9278 (49.5%) were female. Subgroup analysis showed higher 30-day mortality during ECMO (OR 1.11; 95% CI 1.01-1.22; p = .038; I 2 = 0%) in males, but lower 30-day mortality during Impella® therapy than females (OR 0.87; 95% CI 0.80-0.94; p = .001; I 2 = 0%). Males had a higher need of myocardial revascularization (OR 3.09; 95% CI 1.56-5.99; p = .001; I 2 = 0%), but a higher risk of acute kidney injury (OR 1.20; 95% CI 1.09-1.31; p < .001; I 2 = 18%). Conclusion In-hospital and 30-day mortality were similar between females and males.