Sex Differences in Clinical Outcomes Among Patients With Myocarditis-Associated Cardiogenic Shock: A Retrospective Multi-Center Cohort Study.

Myocarditis-associated cardiogenic shock is associated with significant morbidity and mortality, yet sex-based differences in outcomes remain poorly characterized. We conducted a retrospective cohort study using the TriNetX Research Network, a federated electronic health records platform aggregating de-identified data from 99 US health care organizations. Adult patients with concurrent diagnosis of myocarditis and cardiogenic shock from January 1, 2012 to December 31, 2024, were included. After 1:1 propensity score matching, 1,452 men and 1,452 women were identified with balanced baseline characteristics. The risk of all-cause mortality within 6 months of the index date was lower among men compared with women (20.1% vs. 24.0%; HR: 0.82 [95% CI: 0.70 to 0.96]; p = 0.01). Men had higher rates of acute kidney injury (44.0% vs. 38.8%; HR: 1.18 [95% CI: 1.05 to 1.67]; p = 0.004), while rates of new-onset atrial fibrillation/flutter, ventricular tachyarrhythmias, cardiac arrest, and mechanical circulatory support use were similar between sexes. In conclusion, in this large real-world cohort of patients with Myocarditis-associated cardiogenic shock, women sex was associated with higher 6-month mortality despite lower acute kidney injury rates and similar arrhythmia burden and mechanical circulatory support (MCS) use, suggesting that patient sex may be an important prognostic variable warranting further prospective investigation.