Women with cardiogenic shock had similar overall mortality compared to men (55.5% vs 58.3%; p=0.572), despite receiving mechanical circulatory support less frequently (25.3% vs 36.6%; p=0.018).
Cohort (n=441)
No
Are there sex-related differences in the etiology, management, and mortality of patients with cardiogenic shock?
In cardiogenic shock, women present at an older age and receive mechanical circulatory support less frequently than men, but short- and long-term mortality remain similar between sexes.
Absolute Event Rate: 55.5% vs 58.3%
p-value: p=0.572
Abstract Background Cardiogenic shock (CS) is a critical condition and a major cause of mortality despite advances in revascularization and mechanical circulatory support (MCS). Emerging evidence highlights some sex-related differences. Therefore, understanding these disparities is essential to improve care and prognosis in CS. Purpose This study aimed to evaluate sex-related differences among patients with cardiogenic shock admitted to our center. Methods We conducted a single-center retrospective analysis of patients admitted with CS between 2016 and 2025 at our center. A descriptive evaluation including comorbidities, etiology, and management was performed. Additionally, sex-related differences in mortality were assessed. Results A total of 441 patients with CS were included, 146 woman and 295 men. Median age was 67 years IQR 57–78.5); women were older (71 vs 67 years; p=0.036), had higher BMI (p=0.002), and smaller body surface area (p0.001) (Fig.1). Hypertension, diabetes, and chronic kidney disease were similar between sexes. Smoking was more frequent in men (p0.001), who also had higher rates of prior MI (p=0.009), prior PCI (p=0.011), peripheral arterial disease (p=0.008), COPD (p=0.011), and device implantation (ICD p=0.002; CRT p=0.048). Regarding CS etiology, acute myocardial infarction (AMI-CS) was predominant and comparable between sexes (52.7% vs. 50.5%; p=0.659). Acute on chronic CS occurred in 30.4% of patients (26.7% vs 32.2%; p=0.238). Most patients presented with SCAI C (28.4% vs 30%) or D (38.7% vs 36.5%), with no significant differences between sexes (p=0.394). Use of MCS was more frequent in men (36.6% vs 25.3%; p=0.018). VA-ECMO rates were comparable (11% vs 15.9%; p=0.160), but venting was used more often in men (5.5% vs 11.5%; p=0.042). Inotropes were nearly universal, with the use of 3 agents being more frequent in men (17.8% vs 27.8%; p=0.022). Levosimendan was also more commonly used in men (13.7% vs 24.1%; p=0.011). Invasive mechanical ventilation was less frequent in women (46.6% vs 57.6%; p=0.028). Peak creatinine and CRP were higher in men (p=0.007 and p=0.002, respectively). Median hospital stay was 14 days. Overall mortality was 57.4%, similar between sexes (55.5% vs 58.3%; p=0.572). 30-day and 1-year mortality were also comparable (40.4% vs. 41.7% and 53.4% vs. 55.3%; both p0.05). Kaplan–Meier survival showed no significant difference in survival (log-rank p0.05) (Fig.2). A total of 145 patients were treated with MCS. In this group, women had numerically higher mortality 30-day (45.9% vs 38.9%), although not statistically significant (p0.05). Conclusions In this cohort, women with CS presented at an older age and with fewer comorbidities, with no major sex-related differences in etiology or initial severity. They received MCS less frequently. Short- and long-term mortality were similar between sexes, despite numerically higher early mortality in women treated with MCS.Figure 1 Figure 2
Presume et al. (Fri,) conducted a cohort in Cardiogenic shock (n=441). Female sex vs. Male sex was evaluated on Overall mortality (p=0.572). Women with cardiogenic shock had similar overall mortality compared to men (55.5% vs 58.3%; p=0.572), despite receiving mechanical circulatory support less frequently (25.3% vs 36.6%; p=0.018).