The impact of sex on outcomes and interaction with temporary mechanical circulatory support in cardiogenic shock: insights from the Altshock-2 Registry

Cardiogenic shock (CS) is the most severe form of acute heart failure and is characterized by an ominous short-term prognosis.Among potential therapeutic interventions in this setting the use of temporary mechanical circulatory support (tMCS) has increased in recent years;women are often under-represented in all CS studies, particularly in those investigating the impact of tMCS and little is known on the interaction of sex among CS patients treated with tMCS.

To examine the impact of sex on short-term outcomes in CS patients with and without tMCS implantation during hospitalization.

All consecutive CS patients with available data enrolled in the multicenter Altshock-2 registry between January 2020 and November 2023 were selected.The primary outcome was in-hospital all-cause mortality.Results: 692 CS patients (162[23%] women and 530[77%] men, mean age 65 [SD 14] years old) with in-hospital outcome data were selected.The two most common etiologies of CS were acute myocardial infarction-associated CS (259 [58.2%]) and heart failure-associated CS (101 [22.7 %]) equally represented among sexes, whereas acute myocarditis were more prevalent in women than men (7.9% vs 2.3%, p 0.003).Lactate were higher in female vs male patients at presentation (3.4[1.7-7.3] vs. 2.6[1.6-5.3] mmol/l,p=0.03),but no differences in the SCAI stage at presentation emerged between groups (p value 0.3) with SCAI C being the commonest one at admission (53% of patients);445 CS patients were treated with tMCS: 344 (65.3%) of male and 101 (62.7%) of female ones (p value 0.5). IABP was the device most commonly used (73% vs 82% of tMCS in women vs men respectively, p value 0.06), followed by ECMO (33.7% vs 29.7%, p value 0.4) and Impella (18.8vs. 23.5 %, p value 0.3).In-hospital mortality rate in female vs male CS patients were respectively 41.4% and 33.2% in the overall cohort (p=0.06), 41.6% vs 32% in the tMCS cohort (p=0.07) and 41.7% vs 36.1% in the non t-MCS cohort (p=0.5). At multivariate cox regression analyses accounting for relevant baseline confounders, female sex when compared to male one was associated with increased risk of in-hospital mortality both in the overall cohort (adjusted[adj]HR 1.66 [95%CI 1.11-2.49],p value= 0.01] as well as in those receiving tMCS (adjHR 1.84 [1.14-2.97],p value 0.01),but not in those not treated with tMCS (adjHR 1.42 [0.75-2.68],p value 0.3- See Figure 1).There were no significant sex differences in investigators’ reported device-related complications (28%vs. 25%, p = 0.6) or major bleedings (14%vs. 11%, p = 0.3).