Sex Differences in Non-Acute Myocardial Infarction Cardiogenic Shock: Insights from the Northwell-Shock Registry

Abstract

Background: While the role of sex-based differences in acute myocardial infarction-related cardiogenic shock (AMI-CS) is well described, their relevance among patients with non-acute myocardial infarction-related CS (nonAMI-CS) is less well known. Methods: Adult patients treated for cardiogenic shock (CS) between 2016 and 2022 across eleven hospitals within our health system were included. NonAMI-CS etiologies were classified as heart failure or secondary CS (valvular and arrhythmia-triggered). Stratification by sex was used to compare characteristics, management strategies, and outcomes between men and women. Logistic regression models were used to examine the effect of clinical characteristics and management strategies on hospital mortality by sex, along with the effect of sex on different management strategies. Results: Of 2256 patients, women comprised the minority (36%) and also exhibited older age and more comorbidities. Both sexes displayed similar presenting shock stages, according to those established by the Society for Cardiovascular Angiography and Interventions (SCAI). Valvular shock was the only etiology which was more prevalent in women. Women received fewer invasive interventions, including treatment with pulmonary artery catheters (44% vs. 53%; p < 0.01) and mechanical circulatory support devices (15% vs. 22%; p < 0.01). While sex was not independently associated with increased mortality (OR = 1.16, 95% CI = 0.68–1.96), women were more likely to be discharged to skilled nursing facilities (SNF). Conclusions: Although women with nonAMI-CS exhibit a higher risk profile and undergo fewer invasive procedures, their survival rate is comparable to that of men. However, women are more likely to require SNF care upon discharge.