Abstract 4146941: Sex Differences in Utilization and Outcomes of Peripheral Left Ventricular Assist Devices in ST Elevation Myocardial Infarction Associated Cardiogenic Shock in the United States

Background: Peripheral Left Ventricular Assist Devices (pLVAD) are used to achieve rapid ventricular unloading and improve systemic perfusion in myocardial infarction (MI) associated cardiogenic shock (CS). We aim to compare sex-based differences in utilization and outcomes of pLAVD use in ST elevation MI (STEMI) associated CS. Methods: Nationwide Readmissions Database (2016-2021) was used to identify STEMI-CS patients who underwent pLVAD placement. Mahalanobis Distance Matching within the Propensity Score Caliper was used to match males and females. Inverse Probability Weighting (IPW) was utilized, and Pearson’s chi-squared test was applied to the PSM-2 matched cohorts to compare outcomes. Results: Among 27,664 hospitalizations of STEMI-CS patients undergoing pLVAD support, only one-fourths (N: 7,358; 27.2%) of the patients were females. After propensity matching (N: 4,301 in each group), females had significantly higher mortality (52.1% vs. 46.8%, aOR:1.42 [95% CI: 1.29-1.55], p <0.001), pericardial complications (including hemopericardium, cardiac tamponade, pericarditis or any need for pericardiocentesis) (3% vs. 1.8%, aOR:1.50 [95%CI: 1.15-1.96], p <0.001) and blood transfusion requirement (17% vs. 14.4%, aOR:1.32 [95% CI:1.17-1.48 ], p <0.001). From 2016-2021, mortality of STEMI-CS has remained unchanged (males: 37%; females: 40%) (p-trend > 0.05). However, a decline in pLVAD utilization was observed in both males (48% to 41.6%, p-trend <0.001) and females (39% to 32.8%, p-trend <0.001). No significant difference was observed in 30-day, 90-day and 180-day readmission rates between the two groups (p>0.05). Conclusion: Females had higher mortality and complication in STEMI-CS requiring pLVAD utilization. Mortality of STEMI-CS has not changed significantly across the years; however, utilization of pLVAD has been decreasing.