Sex Differences in Acute Myocardial Infarction Complicated by Cardiogenic Shock Supported With pLVAD

Document Type

Conference Proceeding

Publication Date

5-2025

Publication Title

Journal of the Society for Cardiovascular Angiography and Interventions

Abstract

Background: Historically, women with acute myocardial infarction complicated by cardiogenic shock (AMICS) receive fewer evidencedbased therapies and have worse mortality than men. Methods: This study combines data from RECOVER III (NCT04136392) and the National Cardiogenic Shock Initiative (NCT03677180) which were prospective, single-arm, multicenter, observational studies enrolling patients who underwent percutaneous coronary intervention (PCI) for AMICS and received percutaneous left ventricular assist device (pLVAD) support as part of standard of care. We compared patient comorbidities, presentation, treatments, and outcomes stratified by sex. We conducted a multivariable analysis to understand the relationship between sex and in-hospital survival, after covariate adjustment. Results: In total, 804 patients (24% female) were enrolled from 2016 to 2020 across 116 centers in the US. Females were older (median age 66 vs. 63, p=0.001), more often Black (16% vs. 9%, p=0.02), and had higher rates of diabetes (52% vs. 40%, p=0.006) and chronic kidney disease (20% vs. 13%, p=0.04). Both sexes had similar rates of cardiac arrest (69%), number of vasoactive medications (median 1), and shock severity (49% SCAI Stage E) prior to PCI. Pre-PCI heart rate and systolic blood pressure were similar by sex as was median ejection fraction (25% in both groups). Both sexes had similar rates of pre-PCI pLVAD (64%), pulmonary artery catheter usage (88%), and TIMI 3 flow post-PCI (89%). However, median door to support time was longer for women (128 min. vs. 103 min., p¼0.0006). Survival to discharge was lower among women (55% vs. 63%, p=0.051). After multivariable adjustment for the above characteristics, female sex was no longer associated with significantly worse survival (OR 1.20; 95% CI 0.89-1.62; p=0.23). While a higher number of prepLVAD vasoactive medications was associated with worse survival for both sexes (OR 0.72; 95% CI 0.60-0.86; p=0.0004) they were associated with poorer survival for women (pinteraction = 0.007). Conclusions: In this contemporary cohort of AMICS patients with advanced shock treated aggressively with pLVAD and PCI there were no sex-based differences in survival.

Volume

4

Issue

5 Suppl

First Page

60

Comments

Society for Cardiovascular Angiography and Interventions SCAI 48th Annual Scientific Sessions, May 1-3, 2025, Washington, DC

Last Page

60

DOI

10.1016/j.jscai.2025.102869

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