Relationships between sex and in-hospital outcomes of patients with acute cardiogenic shock receiving mechanical circulatory support

Abstract

Background

Cardiovascular disease is the leading cause of mortality in women. Despite this there is a paucity of data on the impact of sex on utilization and outcomes of temporary mechanical circulatory support (tMCS) in patients hospitalized with Acute Myocardial Infarction (AMI) Cardiogenic Shock (CS).

Methods

We examined the 2016–2019 National Inpatient Sample database to identify cases of AMI-CS. Men were used as our control group, while women comprised our cohort. The primary outcome was in-hospital mortality. Secondary outcomes included the use of tMCS including; left ventricular assist device (LVAD) use, Impella use, and Intra-Aortic Balloon Pump (IABP) use, length of stay (LOS) and total hospitalization cost (THC). Multivariate linear and logistic regression models were used to adjust for confounders.

Results

Among patients hospitalized for AMI (N = 2,622,939), 37.7 % were Female. A Female sex was associated with a higher inpatient mortality (adjusted OR [aOR] 1.06, p < 0.001), a lower likelihood of LVAD use (2.3 % vs. 2.9 % and p < 0.001), IABP use (3.0 % vs. 4.4 % and p < 0.001), Impella use (1.0 % vs. 1.5 % and p < 0.001), a longer mean LOS (4.4 vs 4.3 days and p < 0.001) and lower THC ($88,097 vs. $104,101, p < 0.001) compared to male patients for AMI-CS.

Conclusion

Female patients admitted for AMI-CS were less likely to receive tMCS despite a higher mortality rate and a slightly longer LOS compared to male patients. Further studies are necessary to confirm these findings and elucidate clearer causality for such disparities.