Sex Differences in Management, Time to Intervention, and In-Hospital Mortality of Acute Myocardial Infarction and Non-Myocardial Infarction Related Cardiogenic Shock

Background/Objectives: Cardiogenic shock (CS) is associated with high mortality, particularly in women. With early intervention being a cornerstone of CS management, this study aims to explore whether sex differences exist in the utilization of critical interventions, timing of treatment, and in-hospital mortality for patients with acute myocardial infarction (AMI) and non-AMI-CS. Methods: For this retrospective cohort study, we queried the National Inpatient Sample (years 2016-2021) for CS-related hospitalizations. We assessed sex differences in utilization, timing, and outcomes of CS interventions, adjusting for demographics, comorbidities, and prior cardiac interventions via multivariate logistic regressions. Results: Of 1,052,360 weighted CS hospitalizations, 60% were for non-AMI-CS and 40% were for AMI-CS. Women with CS had lower rates of all interventions. For AMI-CS, women had higher likelihoods of in-hospital mortality after revascularization (adjusted odds ratio 1.15 [95% confidence interval 1.09-1.22]), mechanical circulatory support (MCS) (1.15 [1.08-1.22]), and right heart catheterization (RHC) (1.10 [1.02-1.19]) (all p < 0.001). Similar trends were seen in the non-AMI-CS group. Women with AMI-CS were less likely to receive early (within 24 h of admission) revascularization (0.93 [0.89-0.96]), MCS (0.76 [0.73-0.80]), or RHC (0.89 [0.84-0.95]); women with non-AMI-CS were less likely to receive early revascularization (0.78 [0.73-0.84]) or RHC (0.83 [0.79-0.88]) (all p < 0.001). Regardless of CS type, in-hospital mortality was not significantly different between men and women receiving early MCS or revascularization. Conclusions: Sex disparities in the frequency of treatment of CS persist on a national scale, with women being more likely to die following treatment and less likely to receive early treatment. However, in-hospital mortality does not differ significantly when men and women are treated equally within 24 h of admission, suggesting that early intervention should be made a priority to mitigate sex-based differences in CS outcomes.