Sex-Specific Differences in Management and Outcomes of Cardiogenic Shock Patients With and Without Ischemic Cardiomyopathy

Background and Objectives: Comprehensive data on sex-based differences in the management and outcomes of patients with and without ischemic cardiomyopathy (ICMP) presenting with cardiogenic shock (CS) remain limited. This study aimed to investigate whether clinical management and outcomes differ by sex among CS patients, stratified by underlying etiology. Methods: We analyzed 1,247 CS patients from the RESCUE registry, a multicenter observational cohort, stratified by sex and CS etiology: ICMP (females: 276, males: 730) and non-ICMP (females: 111, males: 130). Primary outcomes included in-hospital and 12-month mortality. Multivariable Cox proportional hazards models and propensity-score matching were used to adjust for confounding factors. Results: Among ICMP patients, females were less likely to undergo coronary angiography (p=0.001), although rates of successful revascularization were similar between sexes (p=0.982). In-hospital 30-day mortality did not differ significantly between females and males in either the ICMP cohort (37.1% vs. 29.5%; adjusted hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.63–1.39; p=0.737) or the non-ICMP cohort (28.3% vs. 25.6%; adjusted HR, 1.23; 95% CI, 0.68–2.22; p=0.493). At 12 months, mortality risk remained comparable between sexes in both ICMP (46.4% vs. 37.1%; adjusted HR, 0.82; 95% CI, 0.57–1.17; p=0.274) and non-ICMP groups (40.1% vs. 41.3%; adjusted HR, 0.91; 95% CI, 0.56–1.45; p=0.685). These findings were consistent after propensity-score matching. Conclusions: There was no significant difference in management, 12-month or in-hospital mortality between females and males, irrespective of the etiology of CS. Trial Registration: ClinicalTrials.gov Identifier: NCT02985008.