Abstract 18559: Sex Differences In Acute Myocardial Infarction Related Cardiogenic Shock Across Different Levels Of Care

Background Previous registry data have suggested important sex-based differences in management and clinical outcomes for patients with acute myocardial infarction related cardiogenic shock (AMI-CS).

Methods: We classified 11 hospitals in a metropolitan health network as different levels of care (LOC) for CS based on their highest mechanical circulatory support (MCS) capability; L1: Durable LVAD, L1A: ECMO, L2: Impella. We identified all patients ≥ 18 years of age treated for AMI-CS (ICD-10 diagnosis codes) from 2016 to 2022. Sex differences in management and hospital outcomes are reported. Descriptive statistics and logistic regression were performed using PRISM version 9.

Results: In our cohort (n=1,956), women were a minority in L1 (30%) and L1A (31%) and L2 (41%) and were older with decreasing LOC, L1: 72y. (61-81), L1A: 74y. (64-82) and L2: 81y. (72-88), p<0.01 for trend.Across LOC, left heart catheterization (LHC) and percutaneous coronary interventions (PCI) were used similarly in women and men, while coronary artery bypass grafting (CABG) in surgical centers (L1 and L1A) and MCS in PCI centers (except L1A) were used more frequently in men (Figure). After adjustment for LOC and other relevant covariates, female sex (aOR: 1.35, 95%CI: 1.09-1.67; p=0.007), age (aOR: 1.04, 95%CI: 1.03-1.05, p<0.001) and admission cardiac arrest (aOR: 5.36, 95%CI: 3.63-8.54, p<0.001) were associated with higher hospital mortality.

Conclusion: In a metropolitan health system, despite similar rates of LHC and PCI across different LOC, women with AMI-CS received less CABG and MCS than men and had higher adjusted hospital mortality.