SCAI/EAPCI/ACVC Expert Consensus Statement on Cardiogenic Shock in Women-SCAI/EAPCI/ACVC Expert Consensus Statement on Cardiogenic Shock in Women

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Video Summary

The webinar discussed the 2025 SCI EAPCI ACVC expert consensus on cardiogenic shock (CS) in women, highlighting significant sex-based disparities in diagnosis, treatment, and outcomes. Despite overall cardiovascular mortality declines, in-hospital mortality from CS remains high, especially among women, who experience treatment delays and are less likely to receive guideline-recommended interventions or mechanical circulatory support (MCS). The consensus emphasizes early, frequent assessments of organ perfusion (like lactate levels), judicious use of pulmonary artery catheters, and early consideration of MCS in women presenting with shock.<br /><br />Panelists presented challenging cases illustrating the complexities of managing CS in women. One case involved a young woman with spontaneous coronary artery dissection (SCAD) causing CS, treated with limited stenting and Impella support, underscoring risks of intracoronary imaging and the need for tailored intervention and long-term management including pregnancy counseling. Another case of a middle-aged woman with mixed shock and advanced coronary disease highlighted delays in diagnosis, challenges in mechanical support due to peripheral arterial disease, and the risks of conservative vs. aggressive intervention strategies. The final case focused on pericardial decompression syndrome, a rare but often fatal complication seen mostly in women with right ventricular dysfunction, demonstrating unique physiological challenges and limited treatment options.<br /><br />Experts underscored knowledge gaps, especially due to underrepresentation of women in CS trials, and debated the ethical and logistical challenges of conducting women-only RCTs. While recognizing these hurdles, panelists agreed on the need for improved female-specific research protocols, including strategies addressing vascular access complications and personalized therapy to optimize outcomes. Overall, the consensus document serves as a critical resource to guide future clinical practice and research in cardiogenic shock among women.

Keywords

Cardiogenic Shock

Women

Sex-based Disparities

Mechanical Circulatory Support

Pulmonary Artery Catheter

Spontaneous Coronary Artery Dissection

Intracoronary Imaging

Pericardial Decompression Syndrome

Female-specific Research

Cardiovascular Outcomes