Treatment goals guide cardiogenic shock care more often in women

New findings from the Northwell-Shock Registry show that while women with acute myocardial infarction-related cardiogenic shock (AMI-CS) are less likely to receive invasive treatments, clinical decisions are driven by objective markers of illness severity rather than sex. However, the framing for those decisions differs between men and women, suggesting significant differences in how treatment options are discussed with patients and caregivers. Researchers presented the late-breaking data today at the Society for Cardiovascular Angiography & Interventions (SCAI) 2026 Scientific Sessions & Canadian Association of Interventional Cardiology/Association Canadienne de cardiologie d'intervention (CAIC-ACCI) Summit in Montreal.

AMI-CS occurs when a heart attack severely impairs the heart's ability to pump enough blood to sustain vital organ function. Cardiogenic shock occurs in up to 10% of acute heart attacks and is the leading cause of death after an acute event. Women with AMI-CS experience higher mortality and are less likely to undergo invasive procedures than men, but the reasons behind these differences remain unclear. 

The study included 1,374 patients (31.4% female) with AMI-CS from the Northwell-Shock registry who were treated at 13 hospitals in New York between January 2016 and August 2022. Chart reviews were performed to determine the reasons cited by clinicians for deferral of invasive treatment. Multivariable regression was then performed to determine whether female sex was independently associated with a conservative management strategy. 

Women received a lower rate of Invasive coronary angiography (ICA) than men (78% vs. 86%, p<0.01). However, among women who did receive ICA, rates of subsequent PCI were comparable to men (57% vs. 58%, p=0.8). The leading documented reason for deferral among women was patient or family preference, which occurred nearly twice as often as in men (47% vs. 24%, p<0.01). For men, complicating medical conditions and severe neurologic dysfunction were cited most frequently for not undergoing invasive treatment. Although concurrent complicating conditions played a role in both sexes, discussions regarding goals of care guided decisions two times more often in women compared to men (47% vs. 24%). After adjusting for different factors like age, renal function, AMI type, and the presence of cardiac arrest, sex 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 those differences have not been fully explored. We were expecting to find subtle differences, but were surprised by the clear difference between men and women in how goals of care play a determinant role. This study shows that the way we communicate information to patients and their families can significantly influence decision-making and may ultimately affect outcomes."

Miguel Alvarez Villela, MD, interventional heart failure cardiologist at Northwell Health, New York