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Outcomes in Women With Cardiogenic Shock
Quick Takes
- This study reports that sex-specific differences in outcomes for cardiogenic shock (CS) were primarily driven by the differences in the HF-CS, but not the AMI-CS, cohort.
- Women with HF-CS had higher rates of more severe CS, worse survival at hospital discharge, and more vascular complications.
- Additional studies focusing on women with CS are needed to identify predictors of survival and association of temporary MCS types and complication rates to improve outcomes of women with CS.
Study Questions:
What is the survival rate at discharge among women versus men with cardiogenic shock (CS) complicating acute myocardial infarction (AMI-CS) and heart failure (HF-CS)?
Methods:
The investigators analyzed 5,083 CS patients in the Cardiogenic Shock Working Group. The primary outcome was survival at discharge. Secondary outcomes included orthotopic heart transplantation or left ventricular assist device (LVAD) implantation during index admission. Complications included out-of-hospital cardiac arrest, stroke, in-hospital cardiac arrest, limb ischemia, acute kidney injury, vascular complication requiring intervention or surgery, bleeding requiring surgery, and bleeding requiring transfusions. Propensity-score matching (PSM) was performed with the use of baseline characteristics. Logistic regression was performed for log odds of survival.
Results:
Among 5,083 patients, 1,522 were women (30%), whose mean age was 61.8 ± 15.8 years. There were 30% women and 29.1% men with AMI-CS (p = 0.03). More women presented with de novo HF-CS compared with men (26.2% vs. 19.3%; p < 0.001). Before PSM, differences in baseline characteristics and sex-specific outcomes were seen in the HF-CS cohort, with worse survival at discharge (69.9% vs. 74.4%; p = 0.009) and a higher rate of maximum Society for Cardiac Angiography and Interventions (SCAI) stage E (26% vs. 21%; p = 0.04) in women than in men. Women were less likely to receive pulmonary artery catheterization (52.9% vs. 54.6%; p < 0.001), heart transplantation (6.5% vs. 10.3%; p < 0.001), or LVAD implantation (7.8% vs. 10%; p = 0.01). Regardless of CS etiology, women had more vascular complications (8.8% vs. 5.7%; p < 0.001), bleeding (7.1% vs. 5.2%; p = 0.01), and limb ischemia (6.8% vs. 4.5%; p = 0.001). More vascular complications persisted in women after PSM (10.4% women vs. 7.4% men; p = 0.06).
Conclusions:
The authors report that women with HF-CS had worse outcomes and more vascular complications than men with HF-CS.
Perspective:
This study reports that sex-specific differences in outcomes for CS were primarily driven by the differences in the HF-CS, but not the AMI-CS, cohort. Women with HF-CS had more severe CS including baseline SCAI stage D and maximum SCAI stage E, worse survival at hospital discharge, and more vascular complications. They were also less likely to receive pulmonary artery catheter, temporary mechanical circulatory support (MCS), and heart replacement therapies compared with men. Additional studies focusing on women with CS are needed to identify predictors of survival and association of temporary MCS types and complication rates to improve outcomes of women with CS.
Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure, Acute Coronary Syndromes, Heart Transplant
Keywords: AHA23, Heart Failure, Shock, Cardiogenic, Women
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