Sex-based differences in baseline characteristics and outcomes among patients treated with microaxial flow pump support for cardiogenic shock
A Apostolos, V Galusco, K Konstantinou, D Wong, J Wong, F Bruno, A Sakalidis, A Finanzati, F Riesgo Gil, T Kabir, A Rosenberg, C Vandenbriele, M Monteagudo-Vela, V PanoulasAbstract
Background
Cardiogenic shock remains a leading cause of mortality in acute cardiovascular emergencies, with microaxial flow pump (MAFP) support increasingly used as a haemodynamic rescue strategy. However, sex-based differences in clinical presentation, device utilisation, and outcomes among MAFP-supported patients remain poorly described.
Purpose
To evaluate sex-based differences among consecutive patients receiving MAFP support at two tertiary cardiovascular centres.
Methods
We retrospectively analysed 267 consecutive patients, who received MAFP support at two tertiary hospitals between January 2018 and February 2026. Baseline demographics, comorbidities, diagnosis, Society for Cardiovascular Angiography and Interventions (SCAI) shock stage, device type, and outcomes were compared between sexes. Continuous variables are presented as median [interquartile range] and compared using Mann-Whitney U test. Categorical variables are presented as n (%) and compared using Chi-square or Fisher’s exact test as appropriate. Statistical significance was set at P < 0.05.
Results
Women comprised 24.0% (64/267) of the cohort. Male patients were significantly older than females (median 56 [46–65] vs 47 [36–61] years; P = 0.004) and had higher body mass index-related anthropometrics (height, weight, body surface area; all P < 0.001). The comorbidity burden was comparable between sexes, with no significant differences in hypertension, diabetes mellitus, chronic kidney disease, or chronic heart failure. The distribution of underlying diagnoses differed significantly between sexes (P < 0.001). Men more frequently presented with ST-elevation myocardial infarction (STEMI; 39.3% vs 28.1%) and dilated cardiomyopathy acute decompensated heart failure (DCM ADHF; 27.4% vs 15.6%), whereas acute myocarditis was significantly more prevalent in women (28.1% vs 5.0%). SCAI shock severity was similar, with 65.0% of males and 73.4% of females presenting in SCAI stage ≥D (P = 0.222). Cardiac arrest rates were non-significantly higher in women (41.0% vs 34.2%; P = 0.337). Despite these differences in presentation, 30-day mortality was comparable between males and females (44.6% vs 49.1%; P = 0.560), as was in-hospital mortality (61.2% vs 64.5%; P = 0.739). Median duration of MAFP support was also similar (5 [1–9] vs 6 [1–10.5] days; P = 0.347).
Conclusions
In this two-centre cohort of MAFP-supported patients, women represented approximately one quarter of cases and were younger than men. While the underlying aetiologies differed significantly, SCAI shock severity and short-term mortality were comparable between sexes. These findings suggest that, despite differing pathophysiology, MAFP support provides equitable short-term outcomes regardless of sex. Prospective, larger-scale studies are warranted to further delineate sex-specific phenotypes and inform tailored management strategies in mechanical circulatory support.Figure