Abstract Body (Do not enter title and authors here): Background:
Sex-based disparities in cardiogenic shock (CS) remain underexplored, particularly when stratified by etiology—Acute Myocardial Infarction (AMI) versus Heart Failure (HF). The limited existing studies offer inconsistent findings, and the impact of sex on outcomes remains inadequately defined.

Objective:
To assess sex-based differences in in-hospital mortality among patients with CS, stratified by AMI-CS and HF-CS etiologies.

Methods:
This retrospective cohort study included adult patients presenting in Cardiogenic Shock to two tertiary care centers in Indiana from Jan 2020 to Dec 2023. Using clinical documentation and diagnostic coding, data was categorized into AMI-CS and HF-CS. Baseline demographics, comorbidities and outcomes were compared between sexes within each CS subtype. Primary outcome was in-hospital mortality. Multivariate logistic regression was used to compare outcomes between the groups.

Results:
Among 684 CS patients (AMI-CS: 442; HF-CS: 242), 33.9% were female. Female patients were older in both AMI-CS (mean age 69.1 vs. 65.3, p<0.01) and HF-CS (mean age 68.5 vs 63.0, p<0.01), and had a higher prevalence of hypertension. Women also had higher in-hospital mortality in AMI-CS (49.4% vs. 36.8%, p = 0.03) and HF-CS (45.4% vs. 33.9%, p = 0.04). After adjustment, female sex remained independently associated with higher mortality in AMI-CS (adjusted OR 1.22, 95% CI 1.08–1.40, p = 0.02) and HF-CS (adjusted OR 1.18, 95% CI 1.06-1.38, p = 0.03).

Conclusion:
Female patients experience higher in-hospital mortality in both AMI-related and HF-related Cardiogenic Shock. These disparities persist after adjustment for baseline and clinical factors. Women presented with greater severity of shock and were less likely to receive device based interventions. Larger studies are necessary to investigate these findings further and to identify potential targeted interventions.