Female Sex, Treatment, and Outcomes in Cardiogenic Shock

By Maryjane Farr, M.D., M.Sc.

Professor of Internal Medicine
Section Chief of Heart Failure, LVAD, and Cardiac Transplantation

As principal investigator for the Cardiogenic Shock Working Group at UTSW, I collaborated with Massachusetts General Hospital’s Van-Khue Ton, M.D., Ph.D., and others to report on one of the largest contemporary analyses of real-world registry data on the characteristics and outcomes of women vs. men in cardiogenic shock. Dr. Ton presented results of this multisite collaboration at #AHA23 and was lead author of the simultaneous publication of the work in JACC: Heart Failure.

A total of 5,083 patients were studied, including 1,522 women (30%) with a mean age of 61.8 years. Sex differences were seen in patients presenting with heart failure rather than acute myocardial infarction cardiogenic shock (CS-HF vs. CS-AMI). There were 30% women and 29.1% men with CS-AMI (p < 0.03). More women presented with de novo CS-HF compared to men (26.2% vs. 19.3%; p < 0.001). Women who presented with CS-HF were sicker, with higher Society of Cardiac Angiography and Interventions Stage (SCAI D), and more likely to reach maximum SCAI E than men (26% vs. 21%; p = 0.04) but less likely to be managed with a pulmonary artery catheter or placed on temporary mechanical circulatory support (tMCS). Women with CS-HF had lower rates of survival (69.9% vs. 74.4%; p < 0.009) and were less likely to receive heart transplant (6.5% vs. 10.3%; p < 0.001) or durable left ventricular assist device surgery (7.8% vs. 10%; p, 0.01) as compared to men. Women were more likely to have complications of vascular injury, limb ischemia, and bleeding requiring surgical intervention. These sex differences resolved with propensity score matching (25% of the cohort) except for increased vascular complications. BMI and BSA were used in propensity matching, so larger men and smaller women could not be matched, which might have affected the results.

These data represent one of the largest studies of women presenting in CS-HF. Our findings suggest women and men who present in cardiogenic shock may receive different clinical management, with women having less opportunity for advanced therapies including LVAD and HT. Women had more vascular complications, likely associated with smaller vessel size for standard tMCS cannulation.

Overall, these data indicate that sex-specific research on care pathways for CS are indicated, in addition to development and utilization of tMCS with better size matching for women.

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