Abstract 4365268: Gender Based Disparities in the Utilization and Outcomes of Mechanical Circulatory Support Devices Use Among Patients with Myocardial Infarction: Insights From a Nationwide Data Analysis

Abstract

Background: Studies have revealed Gender-based differences in the management and outcomes of myocardial infarction (MI), with women often facing a poorer prognosis compared to men. Our study aims to analyze the gender based disparities in the clinical outcomes and the overall utilization of mechanical circulatory support (MCS) devices among patients with myocardial infarction (MI). Methods: A retrospective analysis was carried out using data from the National Inpatient Sample, focusing on patients admitted with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) between 2016 and 2022. The study examined the use of mechanical circulatory support (MCS) devices, which included intra-aortic balloon pumps (IABP), percutaneous left ventricular assist devices (pLVAD), and extracorporeal membrane oxygenation (ECMO). It also assessed in-hospital mortality rates, stratified by Gender, among patients with myocardial infarction. Results: Among 2,604,638 patients hospitalized with myocardial infarction, significant disparities were observed between men and women in both clinical presentation and management. Women were more likely to present with NSTEMI and had a higher prevalence of premature coronary artery disease (34.8% vs. 20.8%, p <0.001). In contrast, men were more likely to present with STEMI (27.1% vs. 19.7%, p <0.001). Despite the higher prevalence of NSTEMI in women, they underwent fewer invasive procedures compared to men, including coronary angiography (68.5% vs. 76.4%, p <0.001), percutaneous coronary intervention (44.6% vs. 56.6%, p <0.001), and coronary artery bypass grafting (6.5% vs. 11.0%, p <0.001). The overall use of mechanical circulatory support devices in men vs women (6.1% vs 4.2%, p <0.001), with intra-aortic balloon pumps (IABP)(4.4% vs 3.1%, p <0.001), extracorporeal membrane oxygenation ECMO (0.3% vs 0.2%, p < 0.001), and percutaneous left ventricular assist devices (pLVAD)(1.8% vs 1.2%, p <0.001), use lower in women. Notably, in-hospital mortality was significantly higher among women compared to men (5.5% vs. 4.7%, p <0.001). Conclusion: There are significant gender based disparities in the management and outcomes of myocardial infarction. Women are less likely to receive invasive procedures and advanced device support, even though they experience higher in-hospital mortality rates. These findings highlight the urgent need for more equitable care strategies to address these inequities and to improve outcomes.