Impact of Female Sex on Cardiogenic Shock Outcomes: A Cardiogenic Shock Working Group Report

Van Khue Ton, Manreet K. Kanwar, Borui Li, Vanessa Blumer, Song Li, Elric Zweck, Shashank S. Sinha, Maryjane Farr, Shelley Hall, Rachna Kataria, Maya Guglin, Esther Vorovich, Jaime Hernandez-Montfort, A. Reshad Garan, Mohit Pahuja, Saraschandra Vallabhajosyula, Sandeep Nathan, Jacob Abraham, Neil M. Harwani, Gavin W. HickeyDetlef Wencker, Andrew D. Schwartzman, Wissam Khalife, Claudius Mahr, Ju H. Kim, Arvind Bhimaraj, Paavni Sangal, Yijing Zhang, Karol D. Walec, Peter Zazzali, Daniel Burkhoff, Navin K. Kapur

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Background: Studies reporting cardiogenic shock (CS) outcomes in women are scarce. Objectives: The authors compared survival at discharge among women vs men with CS complicating acute myocardial infarction (AMI-CS) and heart failure (HF-CS). Methods: The authors analyzed 5,083 CS patients in the Cardiogenic Shock Working Group. Propensity score matching (PSM) was performed with the use of baseline characteristics. Logistic regression was performed for log odds of survival. Results: Among 5,083 patients, 1,522 were women (30%), whose mean age was 61.8 ± 15.8 years. There were 30% women and 29.1% men with AMI-CS (P = 0.03). More women presented with de novo HF-CS compared with men (26.2% vs 19.3%; P < 0.001). Before PSM, differences in baseline characteristics and sex-specific outcomes were seen in the HF-CS cohort, with worse survival at discharge (69.9% vs 74.4%; P = 0.009) and a higher rate of maximum Society for Cardiac Angiography and Interventions stage E (26% vs 21%; P = 0.04) in women than in men. Women were less likely to receive pulmonary artery catheterization (52.9% vs 54.6%; P < 0.001), heart transplantation (6.5% vs 10.3%; P < 0.001), or left ventricular assist device implantation (7.8% vs 10%; P = 0.01). Regardless of CS etiology, women had more vascular complications (8.8% vs 5.7%; P < 0.001), bleeding (7.1% vs 5.2%; P = 0.01), and limb ischemia (6.8% vs 4.5%; P = 0.001). More vascular complications persisted in women after PSM (10.4% women vs 7.4% men; P = 0.06). Conclusions: Women with HF-CS had worse outcomes and more vascular complications than men with HF-CS. More studies are needed to identify barriers to advanced therapies, decrease complications, and improve outcomes of women with CS.

Original languageEnglish (US)
Pages (from-to)1742-1753
Number of pages12
JournalJACC: Heart Failure
Volume11
Issue number12
DOIs
StatePublished - Dec 2023

Keywords

  • cardiogenic shock
  • heart failure
  • women

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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