Abstract 4146216: Sex Differences in Cardiogenic Shock: A Meta-Analysis of Outcomes per Etiology (Myocardial Infarction versus Heart Failure)

Background: Acute myocardial infarction complicated by cardiogenic shock (AMICS) and acute heart failure with cardiogenic shock (AHFCS) are associated with high morbidity and mortality. While women are underrepresented in clinical trials and observational studies of these conditions, emerging evidence suggests potential sex-based differences in presentation, management, and outcomes. Understanding these differences is crucial for tailoring treatment strategies and improving outcomes for both men and women. Methods: We conducted a systematic review and meta-analysis of studies reporting sex-specific outcomes in patients with AMICS and AHFCS. A comprehensive search of PubMed, Scopus, and Embase was performed using relevant keywords. 20 Studies reporting outcomes stratified by sex were included. Pooled effect sizes for outcomes were calculated using random-effects models, and heterogeneity was assessed. Subgroup analyses were performed. Results: In this study of patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) and acute heart failure with cardiogenic shock (AHFCS), men had a significantly lower risk of mortality compared to women (AMICS: RR 0.82, 95% CI 0.74-0.91; AHFCS: RR 0.84, 95% CI 0.75-0.94). In the AMICS group, men were more likely to undergo revascularization (RR 1.15, 95% CI 1.08-1.23) and receive mechanical circulatory support (RR 1.26, 95% CI 1.19-1.34). However, there was no statistically significant difference in tMCS use between male and female patients with AHFCS (RR 0.98, 95% CI 0.83 - 1.16). Men in the AMICS group also experienced a lower risk of major bleeding (RR 0.78, 95% CI 0.54-1.13) but a slightly higher risk of major adverse cardiovascular events (MACE) (RR 1.04, 95% CI 0.96-1.12). Conclusion: Our meta-analysis reveals significant sex-based differences in outcomes and treatment patterns among patients with cardiogenic shock. Men consistently demonstrate a lower in-hospital mortality risk across both AMICS and AHFCS, despite a slightly higher risk of MACE in AMICS. This survival advantage may be partially attributed to increased utilization of revascularization and mechanical circulatory support in men. These findings emphasize the need for further research to elucidate the underlying mechanisms driving these sex-based disparities.