Sex Disparities in Cardiogenic Shock: Risk Factors, Treatment Intensity, and Mortality in a Single Latin American Country

Abstract

Background: Cardiogenic shock (CS) carries a high in-hospital mortality, with limited data on sex-related disparities in Latin America. Women remain underrepresented in CS studies. Objectives: To evaluate sex-specific differences in characteristics, management, and mortality in acute myocardial infarction-related (AMI-CS) and non-AMI-CS in a large Latin-American cohort. Methods: We retrospectively analyzed 9430 patients (5016 AMI-CS and 4414 nonAMI-CS) with SCAI-CSWG stages B-E in a reference center in Mexico City from 2005 to 2023. The primary outcome was in-hospital mortality. Analyses included multivariable Cox models and propensity score matching (PSM). Results: Women with AMI-CS were older (67 vs. 60 years), had more hypertension (66% vs. 52%) and diabetes (53% vs. 38%), and received less primary reperfusion (62% vs. 71%) and mechanical circulatory support (11.6% vs. 14.7%) than men (all P < 0.05). In non-AMI-CS, women were older (66 vs. 60 years), had more prior heart failure (33% vs. 24%), while men had more chronic obstructive pulmonary disease (COPD) and prior MI (all P < 0.05). Unadjusted mortality was higher in women in AMICS (24.6% vs. 16.3%, HR 1.48, 95% CI 1.28-1.72) and non-AMI-CS (HR 1.18, 95% CI 1.05-1.32). After PSM, mortality differences were not significant in AMI-CS (HR 1.22, 95% CI 1.00-1.48) or non-AMI-CS (HR 1.07, 95% CI 0.92-1.24). Conclusions: Women with CS in Latin America present with greater comorbidity and less aggressive/invasive management. While unadjusted mortality was higher in women, these differences were no longer significant after PSM, indicating that baseline factors and treatment disparities largely explain excess risk.