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Sex-related differences in etiology, management, and outcomes of cardiogenic shock
Session:
Sessão de Posters 23 - Choque cardiogénico: preditores, suporte e desfechos
Speaker:
Márcia Presume
Congress:
CPC 2026
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.4 Acute Cardiac Care – Cardiogenic Shock
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Márcia Presume; Maria Inês Soares; Rita Barbosa; Catarina Santos-Jorge; Rui Miguel Gomes; Samuel Azevedo; Rita Carvalho; Margarida Matias; Ana Rita Bello; João Presume; Jorge Ferreira; Catarina Brízido
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,"sans-serif""><strong><span style="font-family:"Arial","sans-serif""><span style="color:black">Background: </span></span></strong><span style="font-family:"Arial","sans-serif""><span style="color:black">Cardiogenic shock (CS) is a critical condition and a major cause of mortality despite advances in revascularization and mechanical circulatory support (MCS). Emerging evidence highlights important sex-related differences. Therefore, understanding these disparities is essential.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,"sans-serif""><strong><span style="font-family:"Arial","sans-serif""><span style="color:black">Purpose: </span></span></strong><span style="font-family:"Arial","sans-serif""><span style="color:black">This study aimed to evaluate sex-related differences among patients with CS admitted to our center.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,"sans-serif""><strong><span style="font-family:"Arial","sans-serif""><span style="color:black">Methods: </span></span></strong><span style="font-family:"Arial","sans-serif""><span style="color:black">We conducted a single-center retrospective analysis of CS patients admitted between 2016 and 2025 at our center. A descriptive evaluation including comorbidities, etiology, and management was performed. Additionally, sex-related differences in mortality were assessed.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,"sans-serif""><strong><span style="font-family:"Arial","sans-serif""><span style="color:black">Results: </span></span></strong><span style="font-family:"Arial","sans-serif""><span style="color:black">A total of 441 patients with CS were included, 146 woman and 295 men. Median age was 67 years [57–78.5]; women were older (71 vs 67 years; <em>p</em>=0.036), had higher BMI (<em>p</em>=0.002), and smaller body surface area (<em>p</em><0.001). Smoking was more frequent in men (<em>p</em><0.001), who also had higher rates of prior <span style="background-color:white">acute myocardial infarction (AMI)</span> (p=0.009), prior PCI (p=0.011), peripheral arterial disease (p=0.008), COPD (p=0.011), and device implantation (ICD p=0.002; CRT p=0.048). </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,"sans-serif""><span style="font-family:"Arial","sans-serif""><span style="color:black">Regarding etiology, <span style="background-color:white">AMI-CS was </span>predominant and comparable between sexes (52.7% vs 50.5%; <em>p</em>=0.659). Acute on chronic CS occurred in 30.4% of patients (26.7% vs 32.2%; p=0.238). Most patients presented with SCAI stage C (28.4% VS 30%) or D (38.7% and 36.5%), with no differences between sexes (p=0.394).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,"sans-serif""><span style="font-family:"Arial","sans-serif""><span style="color:black">Use of MCS was more frequent in men (36.6% vs 25.3%; p=0.018). VA-ECMO rates were comparable (11% vs 15.9%; p=0.160), but venting was used more often in men (5.5% vs 11.5%; p=0.042). Inotropes were nearly universal (97.7%), with the use of >3 agents being more frequent in men (17.8% vs 27.8%; p=0.022), as levosimendan (13.7% vs 24.1%; p=0.011). Invasive mechanical ventilation was less frequent in women (46.6% vs 57.6%; p=0.028). Peak creatinine and CRP were higher in men (<em>p</em>=0.007 and <em>p</em>=0.002, respectively), whereas nadir Hb, minimum platelets and minimum eGFR did not differ (p>0.05). Lactate at presentation was similar between sexes (3.1 vs. 3.2mmol/L; p=0.890).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,"sans-serif""><span style="font-family:"Arial","sans-serif""><span style="color:black">Median hospital stay was 14 days (p=0.069). Overall mortality was 57.4%, similar between sexes (55.5% vs 58.3%; p=0.572). 30-day and 1-year mortality were also comparable (40.4% vs. 41.7% and 53.4% vs. 55.3%; both <em>p</em>>0.05). Kaplan–Meier survival showed no significant difference in survival (<em>log-rank p</em>>0.05). In the MCS subgroup (n=145), women showed numerically higher 30-day mortality (45.9% vs. 38.9%), though not statistically significant (<em>p</em>>0.05).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,"sans-serif""><strong><span style="font-family:"Arial","sans-serif""><span style="color:black">Conclusions: </span></span></strong><span style="font-family:"Arial","sans-serif""><span style="color:black">In this cohort, women with CS presented at an older age and with fewer comorbidities, with no major sex-related differences in etiology or initial severity. They received MCS less frequently. Short- and long-term mortality were similar between sexes, despite numerically higher early mortality in women treated with MCS.</span></span></span></span></p>
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