Women have a worse prognosis and undergo fewer coronary angiographies after out-of-hospital cardiac arrest than men

TY - JOUR

T1 - Women have a worse prognosis and undergo fewer coronary angiographies after out-of-hospital cardiac arrest than men

AU - Winther-Jensen, Matilde

AU - Hassager, Christian

AU - Kjaergaard, Jesper

AU - Bro-Jeppesen, John

AU - Thomsen, Jakob H

AU - Lippert, Freddy K

AU - Køber, Lars

AU - Wanscher, Michael

AU - Søholm, Helle

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Background: Out-of-hospital cardiac arrest is more often reported in men than in women. Objectives: We aimed to assess sex-related differences in post-resuscitation care; especially with regards to coronary angiography, percutaneous coronary intervention, mortality and functional status after out-of-hospital cardiac arrest. Methods: We included 704 consecutive adult out-of-hospital cardiac arrest-patients with cardiac aetiology in the Copenhagen area from 2007–2011. Utstein guidelines were used for the pre-hospital data. Vital status and pre-arrest comorbidities were acquired from Danish registries and review of patient charts. Logistic regression was used to assess differences in functional status and use of post-resuscitation care. Cox regression was used to assess differences in 30-day mortality. We used ‘smcfcs’ and ‘mice’ imputation to handle missing data. Results: Female sex was associated with higher 30-day mortality after adjusting for age and comorbidity (hazard ratio (HR): 1.42, confidence interval (CI): 1.13–1.79, p<0.01), this was not significant when adjusting for primary rhythm (HR: 1.12, CI: 0.88–1.42, p=0.37). Women less frequently received coronary angiography <24 h in multiple regression after out-of-hospital cardiac arrest (odds ratio (OR)CAG=0.55, CI: 0.31–0.97, p=0.041), however no difference in percutaneous coronary intervention was found (ORPCI=0.55, CI: 0.23–1.36, p=0.19). Coronary artery bypass grafting was less often performed in women (ORCABG: 0.10, CI: 0.01–0.78, p=0.03). There was no difference in functional status at discharge between men and women (p=1). Conclusion: Female sex was not significantly associated with higher mortality when adjusting for confounders. Women less often underwent coronary angiography and coronary artery bypass grafting, but it is not clear whether this difference can be explained by other factors, or an actual under-treatment in women.

AB - Background: Out-of-hospital cardiac arrest is more often reported in men than in women. Objectives: We aimed to assess sex-related differences in post-resuscitation care; especially with regards to coronary angiography, percutaneous coronary intervention, mortality and functional status after out-of-hospital cardiac arrest. Methods: We included 704 consecutive adult out-of-hospital cardiac arrest-patients with cardiac aetiology in the Copenhagen area from 2007–2011. Utstein guidelines were used for the pre-hospital data. Vital status and pre-arrest comorbidities were acquired from Danish registries and review of patient charts. Logistic regression was used to assess differences in functional status and use of post-resuscitation care. Cox regression was used to assess differences in 30-day mortality. We used ‘smcfcs’ and ‘mice’ imputation to handle missing data. Results: Female sex was associated with higher 30-day mortality after adjusting for age and comorbidity (hazard ratio (HR): 1.42, confidence interval (CI): 1.13–1.79, p<0.01), this was not significant when adjusting for primary rhythm (HR: 1.12, CI: 0.88–1.42, p=0.37). Women less frequently received coronary angiography <24 h in multiple regression after out-of-hospital cardiac arrest (odds ratio (OR)CAG=0.55, CI: 0.31–0.97, p=0.041), however no difference in percutaneous coronary intervention was found (ORPCI=0.55, CI: 0.23–1.36, p=0.19). Coronary artery bypass grafting was less often performed in women (ORCABG: 0.10, CI: 0.01–0.78, p=0.03). There was no difference in functional status at discharge between men and women (p=1). Conclusion: Female sex was not significantly associated with higher mortality when adjusting for confounders. Women less often underwent coronary angiography and coronary artery bypass grafting, but it is not clear whether this difference can be explained by other factors, or an actual under-treatment in women.

KW - Aged

KW - Aged, 80 and over

KW - Cardiopulmonary Resuscitation/mortality

KW - Coronary Angiography

KW - Denmark/epidemiology

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Male

KW - Middle Aged

KW - Odds Ratio

KW - Out-of-Hospital Cardiac Arrest/diagnosis

KW - Percutaneous Coronary Intervention

KW - Prognosis

KW - Registries

KW - Retrospective Studies

KW - Risk Assessment

KW - Sex Distribution

KW - Sex Factors

U2 - 10.1177/2048872617696368

DO - 10.1177/2048872617696368

M3 - Journal article

C2 - 29064270

SN - 2048-8726

VL - 7

SP - 414

EP - 422

JO - European Heart Journal: Acute Cardiovascular Care

JF - European Heart Journal: Acute Cardiovascular Care

IS - 5

ER -