Sex differences in patients with out-of-hospital cardiac arrest without ST-segment elevation: A COACT trial substudy.

Coronary Angiography Female Humans Male Netherlands / epidemiology Out-of-Hospital Cardiac Arrest / therapy Percutaneous Coronary Intervention ST Elevation Myocardial Infarction Sex Characteristics

coronary angiography differences out-of-hospital cardiac arrest sex

Journal

Resuscitation

ISSN: 1873-1570

Titre abrégé: Resuscitation

Pays: Ireland

ID NLM: 0332173

Informations de publication

Date de publication:
01 2021

Historique:

received: 24 08 2020

revised: 09 10 2020

accepted: 16 10 2020

pubmed: 16 11 2020

medline: 22 6 2021

entrez: 15 11 2020

Statut: ppublish

Résumé

Whether sex is associated with outcomes of out-of-hospital cardiac arrest (OHCA) is unclear. This study examined sex differences in survival in patients with OHCA without ST-segment elevation myocardial infarction (STEMI). Using data from the randomized controlled Coronary Angiography after Cardiac Arrest (COACT) trial, the primary point of interest was sex differences in OHCA-related one-year survival. Secondary points of interest included the benefit of immediate coronary angiography compared to delayed angiography until after neurologic recovery, angiographic and clinical outcomes. In total, 522 patients (79.1% men) were included. Overall one-year survival was 59.6% in women and 63.4% in men (HR 1.18; 95% CI: 0.76-1.81;p = 0.47). No cardiovascular risk factors were found that modified survival. Women less often had significant coronary artery disease (CAD) (37.0% vs. 71.3%;p < 0.001), but when present, they had a worse prognosis than women without CAD (HR 3.06; 95% CI 1.31-7.19;p = 0.01). This was not the case for men (HR 1.05; 95% CI 0.67-1.65;p = 0.83). In both sexes, immediate coronary angiography did not improve one-year survival compared to delayed angiography (women, odds ratio (OR) 0.87; 95% CI 0.58-1.30;p = 0.49; vs. men, OR 0.97; 95% CI 0.45-2.09;p = 0.93). In OHCA patients without STEMI, we found no sex differences in overall one-year survival. Women less often had significant CAD, but when CAD was present they had worse survival than women without CAD. This was not the case for men. Both sexes did not benefit from a strategy of immediate coronary angiography as compared to delayed strategy with respect to one-year survival. Netherlands trial register (NTR) 4973.

Sections du résumé

BACKGROUND

Whether sex is associated with outcomes of out-of-hospital cardiac arrest (OHCA) is unclear.

OBJECTIVES

This study examined sex differences in survival in patients with OHCA without ST-segment elevation myocardial infarction (STEMI).

METHODS

Using data from the randomized controlled Coronary Angiography after Cardiac Arrest (COACT) trial, the primary point of interest was sex differences in OHCA-related one-year survival. Secondary points of interest included the benefit of immediate coronary angiography compared to delayed angiography until after neurologic recovery, angiographic and clinical outcomes.

RESULTS

In total, 522 patients (79.1% men) were included. Overall one-year survival was 59.6% in women and 63.4% in men (HR 1.18; 95% CI: 0.76-1.81;p = 0.47). No cardiovascular risk factors were found that modified survival. Women less often had significant coronary artery disease (CAD) (37.0% vs. 71.3%;p < 0.001), but when present, they had a worse prognosis than women without CAD (HR 3.06; 95% CI 1.31-7.19;p = 0.01). This was not the case for men (HR 1.05; 95% CI 0.67-1.65;p = 0.83). In both sexes, immediate coronary angiography did not improve one-year survival compared to delayed angiography (women, odds ratio (OR) 0.87; 95% CI 0.58-1.30;p = 0.49; vs. men, OR 0.97; 95% CI 0.45-2.09;p = 0.93).

CONCLUSION

In OHCA patients without STEMI, we found no sex differences in overall one-year survival. Women less often had significant CAD, but when CAD was present they had worse survival than women without CAD. This was not the case for men. Both sexes did not benefit from a strategy of immediate coronary angiography as compared to delayed strategy with respect to one-year survival.

CLINICAL TRIAL REGISTRATION NUMBER

Netherlands trial register (NTR) 4973.

Identifiants

DOI: 10.1016/j.resuscitation.2020.10.026 PMID: 33189807

pubmed: 33189807

pii: S0300-9572(20)30534-7

doi: 10.1016/j.resuscitation.2020.10.026

pii:

doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

Pagination

14-22