Key result
Female sex shows no association with short- or long-term mortality in cardiogenic shock.
Why the study?
Comprehensive data on sex-based differences in the management and outcomes of patients with and without ischemic cardiomyopathy presenting with cardiogenic shock remain limited.
Does sex influence in-hospital management, 30-day in-hospital mortality, and 12-month mortality in patients presenting with cardiogenic shock with and without ischemic cardiomyopathy?
Cohort (n=1,247)
Yes
Does sex influence in-hospital management, 30-day in-hospital mortality, and 12-month mortality in patients presenting with cardiogenic shock with and without ischemic cardiomyopathy?
Hazard Ratio: 0.82 (95% CI 0.57–1.17)
Absolute Event Rate: 46.4% vs 37.1%
p-value: p=0.274
When in-hospital management and revascularization rates are equitable, female and male patients with cardiogenic shock achieve comparable short- and 12-month survival regardless of whether the underlying etiology is ischemic or non-ischemic cardiomyopathy.
Supports similar survival by sex with equitable care in cardiogenic shock; extends to ICMP and non-ICMP but remains hypothesis-generating.
BACKGROUND AND OBJECTIVES: Comprehensive data on sex-based differences in the management and outcomes of patients with and without ischemic cardiomyopathy (ICMP) presenting with cardiogenic shock (CS) remain limited. This study aimed to investigate whether clinical management and outcomes differ by sex among CS patients, stratified by underlying etiology. METHODS: We analyzed 1,247 CS patients from the RESCUE registry, a multicenter observational cohort, stratified by sex and CS etiology: ICMP (females: 276, males: 730) and non-ICMP (females: 111, males: 130). Primary outcomes included in-hospital and 12-month mortality. Multivariable Cox proportional hazards models and propensity-score matching were used to adjust for confounding factors. RESULTS: Among ICMP patients, females were less likely to undergo coronary angiography (p=0.001), although rates of successful revascularization were similar between sexes (p=0.982). In-hospital 30-day mortality did not differ significantly between females and males in either the ICMP cohort (37.1% vs. 29.5%; adjusted hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.63-1.39; p=0.737) or the non-ICMP cohort (28.3% vs. 25.6%; adjusted HR, 1.23; 95% CI, 0.68-2.22; p=0.493). At 12 months, mortality risk remained comparable between sexes in both ICMP (46.4% vs. 37.1%; adjusted HR, 0.82; 95% CI, 0.57-1.17; p=0.274) and non-ICMP groups (40.1% vs. 41.3%; adjusted HR, 0.91; 95% CI, 0.56-1.45; p=0.685). These findings were consistent after propensity-score matching. CONCLUSIONS: There was no significant difference in management, 12-month or in-hospital mortality between females and males, irrespective of the etiology of CS. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02985008.
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Park et al. (2025) conducted a cohort in Cardiogenic shock with and without ischemic cardiomyopathy (n=1,247). Female sex vs. Male sex was evaluated on 12-month all-cause mortality in the ischemic cardiomyopathy (ICMP) cohort (adjusted HR 0.82, 95% CI 0.57-1.17, p=0.274). Female sex was not associated with significant differences in 30-day in-hospital or 12-month mortality compared to male sex among cardiogenic shock patients with ICMP (adjusted HR 0.82) or non-ICMP.
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