Sex Differences In Clinical Outcomes Among Patients With Stress-induced Cardiomyopathy Complicated By Cardiogenic Shock: A Retrospective Multi-center Cohort Study

Abstract

Introduction

Stress-Induced cardiomyopathy, which disproportionately impacts post-menopausal females, may be complicated by cardiogenic shock. However, sex-specific clinical outcomes among patients with stress-induced cardiomyopathy complicated by cardiogenic shock remains relatively understudied.

Methods

This is a retrospective cohort study using an EHR-based data platform from large academic medical centers across the United States (TriNetX, Inc.). We identified a study population of patients diagnosed with cardiogenic shock secondary to stress-induced cardiomyopathy from January 2012 through January 2024. Baseline demographics, clinical characteristics, medication use, and outcomes were defined using standardized ICD-10 codes. We stratified patients by sex, with the primary outcome of all-cause mortality at 6 months. Secondary outcomes included cardiac arrest, acute kidney injury (AKI), atrial fibrillation, and ventricular tachycardia/fibrillation (VT/VF). Propensity score matching (1:1), incorporating demographic factors, comorbidities, and medication usage, was employed to compare the risk of primary and secondary outcomes between groups.

Results

A total of 4,519 individuals were identified as having cardiogenic shock secondary to stress-induced cardiomyopathy. After propensity-score matching, there were 1,476 individuals in each group (Table). Females had a lower risk of all-cause mortality compared with their male counterparts (33.2% vs. 40.7%, HR: 0.78, 95% CI: 0.69-0.88). The females had lower risk of AKI (HR: 0.73, 95% CI: 0.66-0.80), cardiac arrest (HR: 0.86, 95% CI: 0.73-1.00), and VT/VF (HR: 0.76, 95% CI: 0.63-0.92). The risk of atrial fibrillation was similar between males and females (HR: 0.90, 95% CI: 0.76-1.06).

Conclusion

This study unveils a sex-based disparity in clinical outcomes among individuals with stress cardiomyopathy complicated by cardiogenic shock, underscoring the potential influence of sex-specific factors in the pathophysiology of this condition. Further investigations are warranted into the mechanistic underpinnings of sex-associated disparities and for tailoring therapeutic strategies to optimize clinical outcomes.