Sex Differences in Management, Time to Intervention, and In-Hospital Mortality of Acute Myocardial Infarction and Non-Myocardial Infarction Related Cardiogenic Shock

Abstract Background Limited data are available on sex differences in the time to treatment of cardiogenic shock (CS) with and without acute myocardial infarction (AMI). Methods For this retrospective cohort study, we used nationally representative hospital survey data from the National Inpatient Sample (years 2016-2021) to assess sex differences in interventions, time to treatment (within versus after 24 hours of admission), and in-hospital mortality for AMI-CS and non-AMI-CS, adjusting for age, race, income, insurance, comorbidities, and prior cardiac interventions. Results We identified 1,052,360 weighted CS hospitalizations (60% non-AMI-CS; 40% AMI-CS). Women with CS had significantly lower rates of all interventions. For AMI-CS, women had a higher likelihood of in-hospital mortality after: revascularization (adjusted odds ratio (aOR) 1.15 95% CI 1.09-1.22), mechanical circulatory support (MCS) (1.15 1.08-1.22), right heart catheterization (RHC) (1.10 1.02-1.19) (all p<0.001). Similar trends were found for the non-AMI-CS group. Women with AMI-CS were less likely to receive early (within 24 hours of admission) revascularization (0.93 0.89-0.96), MCS (0.76 0.73-0.80), or RHC (0.89 0.84-0.95) than men; women with non-AMI-CS were less likely to receive early revascularization (0.78 0.73-0.84), IABP (0.85 0.78-0.94), pLVAD (0.88 0.77-0.99) or RHC (0.83 0.79-0.88) than men (all p<0.001). For both types of CS, in-hospital mortality was not significantly different between men and women receiving early ECMO, pLVAD, or PCI. Conclusions Sex disparities in the frequency of treatment of CS persist on a national scale, with women being more likely to die following treatment and less likely to receive early treatment. However, when comparing patients who received early treatment, in-hospital mortality does not differ significantly when men and women are treated equally within 24 hours of admission. Early intervention if clinically indicated could mitigate sex-based differences in CS outcomes and should be made a priority in the management of CS. Clinical Perspective What is new? Women have increased in-hospital mortality with cardiogenic shock and have lower odds of early intervention (within 24 hours of admission) compared to men. When men and women with cardiogenic shock are treated equally in terms of early intervention within 24 hours of admission, sex differences in in-hospital mortality disappear. What are the clinical implications? Sex-based disparities are present in the utilization of treatment and time to intervention for patients with cardiogenic shock. Early recognition and intervention for cardiogenic shock among women should be considered to improve clinical outcomes.