Sex-based differences in clinical outcomes among cardiogenic shock patients treated with mechanical circulatory...

Despite advances in therapies, cardiogenic shock (CS) remains associated with high mortality rates, often necessitating mechanical circulatory support (MCS) to preserve end-organ perfusion. Despite increasing rates of MCS utilization, less is known about sex-related differences in clinical outcomes to guide practice. Additionally, standardized management protocols for CS patients requiring MCS that account for sex differences are lacking. In this study, we evaluate sex-specific outcomes in CS patients requiring MCS, examine patterns of MCS utilization by sex, and further stratify clinical outcomes by sex across the overall CS cohort, including the acute myocardial infarction-related CS (AMI-CS), acute heart failure-related CS (AHF-CS), and spontaneous coronary artery dissection-related CS (SCAD-CS) subgroups. We performed a retrospective cohort analysis using the National Inpatient Sample (2016-2020) to identify adult hospitalizations for CS treated with MCS, based on ICD-10 procedure codes. Patients were stratified by sex. Survey-weighted multivariable logistic and linear regression models were employed to assess associations with clinical outcomes. The primary outcome was in-hospital all-cause mortality (ACM). Secondary outcomes included procedural complications, acute kidney injury (AKI), length of stay (LOS), and total hospital charges. Adjusted odds ratios (aOR), 95% confidence intervals (CI), and p-values were reported. Among 161,095 CS patients treated with MCS, 70.2% were male and 29.8% female. Female patients were older (66.0 vs. 63.9 years; p < 0.001) and had significantly higher in-hospital all-cause mortality (32.6% vs. 27.9%; aOR 1.16, 95% CI: 1.09-1.24; p < 0.001). Specifically, female patients had significantly higher in-hospital mortality in both the AMI-CS (30.3% vs. 34.8%; aOR 1.10, 95% CI: 1.03-1.19; p < 0.001) and AHF-CS cohorts (23.2% vs. 25%; aOR 1.12, 95%: 1.02-1.23; p < 0.018). In contrast, no statistically significant sex-based difference in mortality was observed in the SCAD-CS group (30% vs. 28.3%; aOR 1.03, 95% CI 0.64-1.67); p < 0.887). The rates of post-procedural bleeding did not differ significantly between sexes across all causes of CS (4.30% vs. 4.70%; aOR 1.05; 95% 0.92-1.21, p < 0.40). While female patients were at a greater risk of procedural complications (1.5% vs. 0.7%; aOR 1.82, 95% CI: 1.39-2.37; p < 0.001), and cardiac tamponade (3.0% vs. 2.3%; aOR 1.26, 95% CI: 1.06-1.50; p = 0.008), they were less likely to develop AKI (53.2% vs. 60.5%; aOR 0.66, 95% CI: 0.62-0.70; p < 0.001) and less likely to require cardioversion (11.2% vs. 13.1%; aOR 0.83, 95% CI: 0.76-0.90; p < 0.001). Across all forms of mechanical circulatory support (MCS), including ECMO, IABP, and Impella, male patients were consistently more likely to receive MCS compared to female patients. Analysis of temporal trends from 2016 to 2020 revealed no significant changes in MCS utilization patterns between sexes over time. Among patients with cardiogenic shock undergoing MCS, women exhibited higher overall in-hospital mortality and, among AMI-CS and AHF-CS subgroups, had lower healthcare resource utilization. Females demonstrated higher incidence of procedural complication rates, but post-procedural bleeding rates did not differ between the sexes. These findings underscore the importance of incorporating sex-specific considerations into clinical decision-making and management strategies for MCS.