New findings from the Northwell-Shock Registry show that while women with acute myocardial infarction-associated cardiogenic shock (AMI-CS) are less likely to undergo invasive treatment, clinical decisions are driven by objective markers of disease severity rather than gender. However, men and women frame these decisions differently, suggesting significant differences in how treatment options are discussed with patients and caregivers. Researchers presented their latest data today at the Society of Cardiovascular Angiography and Interventions (SCAI) 2026 Scientific Sessions and Canadian Society of Interventional Cardiology/Consortium on Cardiac Interventions (CAIC-ACCI) Summit in Montreal.
AMI-CS occurs when a heart attack severely impairs the heart’s ability to pump enough blood to keep vital organs functioning. Cardiogenic shock occurs in up to 10% of acute heart attacks and is the leading cause of death after the acute event. Women with AMI-CS have higher mortality rates and are less likely to undergo invasive procedures than men, but the reasons behind these differences are still unclear.
The study included 1,374 AMI-CS patients (31.4% women) from the Northwell-Shock registry who were treated at 13 New York hospitals from January 2016 to August 2022. A chart review was performed to determine clinician-cited reasons for deferring invasive procedures. We then performed multivariate regression to determine whether female gender was independently associated with conservative management strategies.
Women were less likely to undergo invasive coronary angiography (ICA) than men (78% vs. 86%, p<0.01). However, among women who underwent ICA, the incidence of subsequent PCI was similar to men (57% vs. 58%, p=0.8). The main reason for deferral for women was patient or family preference, which occurred almost twice as often as for men (47% vs. 24%, p<0.01). For men, complex medical conditions and severe neurological dysfunction were most frequently cited as reasons for not undergoing invasive treatment. Although co-occurring complications were associated with both genders, discussions about goals of care were twice as common in decision-making in women compared with men (47% vs. 24%). After adjusting for various factors such as age, renal function, type of AMI, and presence of cardiac arrest, gender was not independently associated with receiving conservative treatment (OR 1.18; 95% CI 0.80-1.78, p=0.49).
Although sex differences have been observed previously, the underlying mechanisms driving these differences have not been adequately investigated. Although we expected to find subtle differences, we were surprised to find clear differences between men and women in how goals of care play a determining role. This study shows that the way information is communicated to patients and their families can have a significant impact on decision-making and, ultimately, outcomes. ”
Miguel Alvarez Villela, MD, heart failure interventional cardiologist at Northwell Health, New York
sauce:
Society of Cardiovascular Angiography and Interventions
