Care goals for heart attack-related cardiogenic shock inform decisions for men, women differently

Women experiencing acute myocardial infarction-related cardiogenic shock (AMI-CS) undergo invasive procedures less frequently than men, with new data suggesting that these discrepancies are primarily influenced by objective markers of illness and communication styles rather than clinician sex bias, according to new data presented at the Society for Cardiovascular Angiography & Interventions (SCAI) 2026 Scientific Sessions in Montreal, Québec, Canada.¹

However, research also found that the framing and context for those decisions differ among sexes, suggesting that how treatment options are discussed between patients and health care professionals differ.

According to a news release from SCAI, AMI-CS is a life-threatening condition where a heart attack severely compromises the heart's pumping capacity, preventing it from sustaining vital organ function. This complication occurs in up to 10% of acute heart attacks and represents the primary cause of death following such an event, according to research published in JAMA in 2021.² Historically, women with AMI-CS have faced higher mortality rates and lower rates of invasive interventions, according to researchers of a 2023 study published in Current Cardiology Reviews. Despite the understood data, specific mechanisms driving these outcomes have remained poorly understood.^1,3

Women less likely than men to receive ICA

Researchers used data from 1374 patients (31.4% female) treated in 13 New York hospitals from January 2016 to August 22. Investigators performed detailed chart reviews to identify the specific reasons clinicians cited for deferring invasive care and used multivariable regression to determine whether sex was an independent predictor of a conservative management strategy.¹

The analysis showed that women were less likely than men to receive invasive coronary angiography (ICA), with rates of 78% and 86%, respectively (P < .01). However, among the subset of women who did undergo angiography, the rates of subsequent percutaneous coronary intervention (PCI) were similar to those seen in men, at 57% and 58% (P = .8).

Disparities in goals of care discussions

The most striking differences emerged in the documentation of why invasive treatment was bypassed. For women, the leading reason for deferral was the preference of the patient or their family, a factor cited nearly twice as often as it was for men (47% vs. 24%, P < .01). In contrast, men were most frequently denied invasive treatment because of severe neurological dysfunction or complicating medical conditions.

After adjusting for age, renal function, AMI type, and presence of cardiac arrest, the study investigators determined that sex was not independently associated with receiving conservative treatment (OR 1.18; 95% CI 0.80-1.78, P = .49).

“Although sex differences have been observed previously, the underlying mechanisms driving those differences have not been fully explored,” said Miguel Alvarez Villela, MD, in a statement. Villela is an interventional heart failure cardiologist at Northwell Health in New York.

“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,” added Villela. “This study shows that the way we communicate information to patients and their families can significantly influence decision-making and may ultimately affect outcomes.”

Further research, according to the study investigators, is warranted for all existing registries to collect this decision-making data to allow for validation in larger national registries.

References:

1. Among women with heart attack-related cardiogenic shock, goals of care twice as likely to drive management decisions compared to men. Society for Cardiovascular Angiography and Interventions. News release. Published April 23, 2026. Accessed April 23, 2026. https://www.eurekalert.org/news-releases/1125021?
2. Samsky MD, Morrow DA, Proudfoot AG, Hochman JS, Thiele H, Rao SV. Cardiogenic Shock After Acute Myocardial Infarction: A Review. JAMA. 2021 Nov 9;326(18):1840-1850. doi:10.1001/jama.2021.18323.
3. Lunova T, Komorovsky R, Klishch I. Gender Differences in Treatment Delays, Management and Mortality among Patients with Acute Coronary Syndrome: A Systematic Review and Meta-analysis. Curr Cardiol Rev. 2023;19(1):e300622206530. doi:10.2174/1573403X18666220630120259.