Effect of Sex and Gender on the Characteristics and Outcomes of Acute Myocardial Infarction-Related Cardiogenic Shock: A Systematic Review and Meta-Analysis Provisionally Accepted

Huang Jianlin¹ Xiaohong Jiang² Chaoqian Li^1*

• ¹Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, China
• ²Department of Geriatric Respiratory Medicine The First Affiliated Hospital of Guangxi Medical University, China

Background: Acute myocardial infarction (AMI)-related cardiogenic shock (CS) is associated with high morbidity and mortality rates. Numerous studies report sexual dimorphisms in presentation and outcomes of CS. This meta-analysis aims to summarize the existing evidence and investigate the relationships between gender/sex and the characteristics and outcomes of AMI-related CS.Methods: A systematic search of PubMed, EMbase, Google Scholar, and the Cochrane Library databases was done to identify relevant articles published up to May 2023. Studies investigating gender/sex differences in patients with CS following myocardial infarction (MI) were selected according to predefined inclusion criteria. Heterogeneity among the studies was assessed using I 2 statistics, and random-effect models were used for data synthesis.Results: Thirteen studies with a total of 4,649,694 participants were included in the analysis. Significant differences were observed in the ages of onset for AMI-related CS between men and women (SMD = -0.60; 95% CI: -0.78 to -0.41). Male gender was associated with a significantly earlier CS onset compared to female gender. Overall mortality rates were comparable in both genders (OR = 0.84; 95% CI: 0.70 to 1.01). Notably, in female patients, increased odds of developing AMI-related CS were associated with a history of coronary artery bypass surgery (CABG) (OR = 1.50; 95% CI, 1.06 to 2.22), percutaneous coronary intervention (PCI) (OR = 1.34; 95% CI, 1.14 to 1.56), or MI (OR = 1.22; 95% CI: 1.08 to 1.37). Conversely, men were more likely to present with diabetes mellitus (DM) (OR = 0.77; 95% CI, 0.65 to 0.90) and hypertension (OR = 0.84; 95% CI, 0.75 to 0.94) at the time of MI-CS onset compared to women.Our findings demonstrate that sex/gender is associated with significant differences in cardiogenic shock characteristics and outcomes. Our results further underscore the need for sex-specific strategies to enhance risk assessment, management, and treatment of patients with AMI-related CS.