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Comparing the Outcomes of Cardiogenic Shock After Myocardial Infarction in Women Across Different Age Groups
Nformbuh Asangmbeng1, Frank H Annie1, Kerry Drabish1
1Department of Cardiology, Charleston Area Medical Center, Charleston, USA.
Insights
Older women with myocardial infarction (MI) and cardiogenic shock (CS) have higher mortality and atrial fibrillation risk. Younger women experienced more emergency readmissions, indicating a need for age-specific care strategies.
Area of Science:
- Cardiology
- Geriatric Medicine
- Women's Health
Background:
- Cardiogenic shock (CS) following myocardial infarction (MI) presents significant morbidity and mortality risks.
- Female patients often have distinct clinical presentations and outcomes post-MI, yet age-stratified data for CS is limited.
Purpose of the Study:
- To compare outcomes of post-MI CS in women aged 45-55 versus 56-75 years.
- To identify age-specific risks and trends in female patients experiencing CS after MI.
Main Methods:
- Retrospective cohort study using deidentified electronic health records (2017-2023) from 102 healthcare organizations.
- Propensity score matching (1:1) of 1,100 female patients aged 45-55 and 1,100 aged 56-75 with acute MI and CS.
- Three-year follow-up assessing all-cause mortality, MACE, arrhythmias, Afib, device procedures, and readmissions.
Main Results:
- Older women (56-75) exhibited significantly higher three-year mortality (41.2% vs. 36.2%) and increased atrial fibrillation (Afib) incidence (26.5% vs. 22.7%).
- Major adverse cardiac events (MACE) and other arrhythmias were similar between age groups.
- Younger women (45-55) had more frequent emergency readmissions (33.7% vs. 29.3%).
Conclusions:
- Age-related disparities exist in post-MI CS outcomes among women.
- Older women face elevated mortality and Afib risks, while younger women experience higher readmission rates.
- Findings suggest the necessity for age-tailored post-discharge care strategies for women with CS post-MI.
Background:
Cardiogenic shock (CS) complicating myocardial infarction (MI) is associated with high morbidity and mortality, with age- and sex-specific differences in presentation and outcomes. Female patients, often underrepresented in cardiovascular research, exhibit distinct clinical profiles and treatment patterns. However, age-stratified outcomes among women with post-MI CS remain insufficiently described.
Aim:
This study aimed to compare the outcomes of post-MI CS between female patients in two distinct age groups: 45-55 and 56-75 years.
Methods:
We conducted a retrospective cohort study using the TriNetX Research Network, including deidentified electronic health records from 102 healthcare organizations between January 1, 2017, and January 1, 2023. Female patients aged 45-55 or 56-75 years with both acute MI (International Classification of Diseases, 10th Revision, ICD-10: I21) and CS (ICD-10: R57.0) were identified. Two cohorts were generated and matched 1:1 using propensity scores for demographics and comorbidities, resulting in 1,100 patients per group. Outcomes assessed included all-cause mortality, major adverse cardiac events (MACE), arrhythmias, atrial fibrillation (Afib), cardiac device procedures/complications, and emergency readmissions over a three-year follow-up. Outcomes were compared using Kaplan-Meier analysis and Cox proportional hazards models.
Results:
Older women (56-75 years) had significantly higher three-year mortality compared to the younger cohort (41.2% vs. 36.2%, p = 0.016), as well as increased incidence of Afib (26.5% vs. 22.7%, p = 0.038). Rates of MACE and other arrhythmias were similar between the groups. Emergency readmissions were more common in younger women (33.7% vs. 29.3%, p = 0.025), while device-related procedures showed low event rates and group-specific trends. Absolute differences in outcomes were modest.
Conclusions:
Age-related differences exist among female patients with post-MI CS. Older women face higher mortality and Afib risk, while younger women experience more frequent emergency readmissions. These findings highlight the need for age-specific postdischarge strategies, but must be interpreted cautiously given the study's retrospective design, reliance on administrative coding, and lack of granular clinical data. Further prospective research is needed to elucidate the mechanisms and inform tailored interventions for women with CS following MI.
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