Analysis of 254,691 weighted cardiogenic shock hospitalizations revealed substantial sex-based mortality disparities across different shock phenotypes. Women experienced 24-28% higher odds of in-hospital death in acute myocardial infarction-related shock (36.1% vs 31.3%), heart failure-related shock (30.5% vs 25.8%), and arrhythmia-related shock (37.3% vs 31.6%). Simultaneously, women received significantly less mechanical circulatory support, including 40% fewer advanced devices like IABP/Impella. These findings illuminate a critical gap in cardiovascular emergency care that extends beyond previously documented disparities in heart attack treatment. The phenotype-specific analysis represents a meaningful advance over prior research that treated cardiogenic shock as a uniform condition. However, this observational study cannot establish whether treatment differences cause mortality gaps or reflect appropriate clinical judgment based on unmeasured factors like frailty or comorbidities. The large national sample strengthens generalizability, though this preprint awaits peer review and results may change. These disparities demand immediate attention given cardiogenic shock's 30-40% mortality rate and the potential for correctable treatment biases affecting women's survival in cardiovascular emergencies.