Evaluating gender-based disparities in the outcomes of impella use in acute myocardial infarction patients with cardiogenic shock; insights from real-world global data.

Introduction: Mechanical circulatory support (MCS) devices, such as the Impella, have become critical tools in managing cardiogenic shock (CS), offering temporary hemodynamic support to improve cardiac output and stabilize patients. This study aimed to evaluate gender-based differences in clinical outcomes following Impella implantation for CS secondary to myocardial infarction (MI).

Methods: Using real-world data from the TriNetX database, all patients with CS secondary to MI who underwent Impella implantation were identified and then divided into two cohorts based on gender. To minimize selection bias, propensity score matching (PSM) was applied at a 1:1 ratio based on baseline characteristics, including age, race, and comorbidities. Outcomes included in-hospital mortality, acute kidney injury (AKI), cardiac arrest, acute ischemic and hemorrhagic strokes, intraoperative bleeding, acute aortic dissection, critical limb ischemia, acute pulmonary embolism, and readmission rates.

Results: Our analysis identified 6,687 individuals who underwent Impella implantation for cardiogenic shock. After PSM, two matched cohorts comprising 1,760 individuals were included. Male gender was associated with a significantly increased incidence of AKI (RR: 1.21,  < 0.001) and readmission (RR: 1.09,  = 0.006). On the other hand, females had a 60% greater chance of developing critical limb ischemia compared to males (RR: 0.40,  < 0.001). Gender did not impact the incidence of cardiac arrest ( = 0.243), acute ischemic strokes ( = 0.953), pulmonary embolism ( = 0.275), or mortality ( = 0.919). The incidences of hemorrhagic stroke, aortic dissection, and intraoperative bleeding were equal in both groups ( = 1).

Conclusion: Our study showed that male patients had a higher risk of acute kidney injury and readmissions compared to females, whereas females were more likely to experience critical limb ischemia. These findings highlight the need for gender-specific considerations in the management of CS and the use of MCS.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12872-025-04999-9.