No difference in mortality between men and women after out-of-hospital cardiac arrest

Matilde Winther-Jensen; Jesper Kjaergaard; Michael Wanscher; Niklas Nielsen; Jørn Wetterslev; Tobias Cronberg; David Erlinge; Hans Friberg; Yvan Gasche; Janneke Horn; Jan Hovdenes; Michael Kuiper; Tommaso Pellis; Pascal Stammet; Matthew P Wise; Anders Åneman; Christian Hassager

doi:10.1016/j.resuscitation.2015.06.030

No difference in mortality between men and women after out-of-hospital cardiac arrest

Matilde Winther-Jensen, Jesper Kjaergaard, Michael Wanscher, Niklas Nielsen, Jørn Wetterslev, Tobias Cronberg, David Erlinge, Hans Friberg, Yvan Gasche, Janneke Horn, Jan Hovdenes, Michael Kuiper, Tommaso Pellis, Pascal Stammet, Matthew P Wise, Anders Åneman, Christian Hassager

24 Citations (Scopus)

Abstract

Aim: Comparing the outcome after out-of-hospital cardiac arrest (OHCA) in men and women and to determine whether sex modifies the effect of targeted temperature management (TTM) at 33 or 36. °C. Methods: The TTM trial randomized 950 patients to TTM at 33 or 36. °C for 24. h. This predefined sub-study of the TTM trial assessed survival and neurological outcome defined as Cerebral Performance Category (CPC) and modified Rankin Scale (mRS) using female sex as main predictor of outcome, in relation to level of TTM and other confounding factors. Results: Compared to men, women more often had OHCA at home, p= 0.04 and less often had bystander defibrillation, p= 0.01. No other differences in arrest circumstances were found. Coronary angiography (CAG) and percutaneous coronary intervention (PCI) <24. h after ROSC was less often performed in women, both: p= 0.02.Female sex was associated with higher mortality in univariate analysis, hazard ratio (HR) = 1.29, CI = 1.04-1.61, p= 0.02 compared to men. Adjusting for demographic factors (age and comorbidity), arrest circumstances, pre-hospital findings, inclusion sites, treatments and status at admission reduced this: HR = 1.11, CI = 0. 87-1.41, p= 0.42, and sex was no longer an independent risk factor for death. The effect of sex did not modify the effect of TTM at 33 and 36°C, p_interaction=0.73. Conclusion: Female sex seems associated with adverse outcome, but this association is largely explained by differences in arrest circumstances and in-hospital treatment. Our data shows no interaction between sex and the effect of targeting 33 vs. 36. °C.

Original language	English
Journal	Resuscitation
Volume	96
Pages (from-to)	78-84
Number of pages	7
ISSN	0300-9572
DOIs	https://doi.org/10.1016/j.resuscitation.2015.06.030
Publication status	Published - Nov 2015

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Winther-Jensen, M., Kjaergaard, J., Wanscher, M., Nielsen, N., Wetterslev, J., Cronberg, T., Erlinge, D., Friberg, H., Gasche, Y., Horn, J., Hovdenes, J., Kuiper, M., Pellis, T., Stammet, P., Wise, M. P., Åneman, A., & Hassager, C. (2015). No difference in mortality between men and women after out-of-hospital cardiac arrest. Resuscitation, 96, 78-84. https://doi.org/10.1016/j.resuscitation.2015.06.030

Winther-Jensen, M, Kjaergaard, J, Wanscher, M, Nielsen, N, Wetterslev, J, Cronberg, T, Erlinge, D, Friberg, H, Gasche, Y, Horn, J, Hovdenes, J, Kuiper, M, Pellis, T, Stammet, P, Wise, MP, Åneman, A & Hassager, C 2015, 'No difference in mortality between men and women after out-of-hospital cardiac arrest', Resuscitation, vol. 96, pp. 78-84. https://doi.org/10.1016/j.resuscitation.2015.06.030

@article{99ffd8ec935744f581d7875b44b0c38a,

title = "No difference in mortality between men and women after out-of-hospital cardiac arrest",

abstract = "Aim: Comparing the outcome after out-of-hospital cardiac arrest (OHCA) in men and women and to determine whether sex modifies the effect of targeted temperature management (TTM) at 33 or 36. °C. Methods: The TTM trial randomized 950 patients to TTM at 33 or 36. °C for 24. h. This predefined sub-study of the TTM trial assessed survival and neurological outcome defined as Cerebral Performance Category (CPC) and modified Rankin Scale (mRS) using female sex as main predictor of outcome, in relation to level of TTM and other confounding factors. Results: Compared to men, women more often had OHCA at home, p= 0.04 and less often had bystander defibrillation, p= 0.01. No other differences in arrest circumstances were found. Coronary angiography (CAG) and percutaneous coronary intervention (PCI) <24. h after ROSC was less often performed in women, both: p= 0.02.Female sex was associated with higher mortality in univariate analysis, hazard ratio (HR) = 1.29, CI = 1.04-1.61, p= 0.02 compared to men. Adjusting for demographic factors (age and comorbidity), arrest circumstances, pre-hospital findings, inclusion sites, treatments and status at admission reduced this: HR = 1.11, CI = 0. 87-1.41, p= 0.42, and sex was no longer an independent risk factor for death. The effect of sex did not modify the effect of TTM at 33 and 36°C, pinteraction=0.73. Conclusion: Female sex seems associated with adverse outcome, but this association is largely explained by differences in arrest circumstances and in-hospital treatment. Our data shows no interaction between sex and the effect of targeting 33 vs. 36. °C.",

author = "Matilde Winther-Jensen and Jesper Kjaergaard and Michael Wanscher and Niklas Nielsen and J{\o}rn Wetterslev and Tobias Cronberg and David Erlinge and Hans Friberg and Yvan Gasche and Janneke Horn and Jan Hovdenes and Michael Kuiper and Tommaso Pellis and Pascal Stammet and Wise, {Matthew P} and Anders {\AA}neman and Christian Hassager",

year = "2015",

month = nov,

doi = "10.1016/j.resuscitation.2015.06.030",

language = "English",

volume = "96",

pages = "78--84",

journal = "Resuscitation",

issn = "0300-9572",

publisher = "Elsevier Ireland Ltd",

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TY - JOUR

T1 - No difference in mortality between men and women after out-of-hospital cardiac arrest

AU - Winther-Jensen, Matilde

AU - Kjaergaard, Jesper

AU - Wanscher, Michael

AU - Nielsen, Niklas

AU - Wetterslev, Jørn

AU - Cronberg, Tobias

AU - Erlinge, David

AU - Friberg, Hans

AU - Gasche, Yvan

AU - Horn, Janneke

AU - Hovdenes, Jan

AU - Kuiper, Michael

AU - Pellis, Tommaso

AU - Stammet, Pascal

AU - Wise, Matthew P

AU - Åneman, Anders

AU - Hassager, Christian

PY - 2015/11

Y1 - 2015/11

N2 - Aim: Comparing the outcome after out-of-hospital cardiac arrest (OHCA) in men and women and to determine whether sex modifies the effect of targeted temperature management (TTM) at 33 or 36. °C. Methods: The TTM trial randomized 950 patients to TTM at 33 or 36. °C for 24. h. This predefined sub-study of the TTM trial assessed survival and neurological outcome defined as Cerebral Performance Category (CPC) and modified Rankin Scale (mRS) using female sex as main predictor of outcome, in relation to level of TTM and other confounding factors. Results: Compared to men, women more often had OHCA at home, p= 0.04 and less often had bystander defibrillation, p= 0.01. No other differences in arrest circumstances were found. Coronary angiography (CAG) and percutaneous coronary intervention (PCI) <24. h after ROSC was less often performed in women, both: p= 0.02.Female sex was associated with higher mortality in univariate analysis, hazard ratio (HR) = 1.29, CI = 1.04-1.61, p= 0.02 compared to men. Adjusting for demographic factors (age and comorbidity), arrest circumstances, pre-hospital findings, inclusion sites, treatments and status at admission reduced this: HR = 1.11, CI = 0. 87-1.41, p= 0.42, and sex was no longer an independent risk factor for death. The effect of sex did not modify the effect of TTM at 33 and 36°C, pinteraction=0.73. Conclusion: Female sex seems associated with adverse outcome, but this association is largely explained by differences in arrest circumstances and in-hospital treatment. Our data shows no interaction between sex and the effect of targeting 33 vs. 36. °C.

AB - Aim: Comparing the outcome after out-of-hospital cardiac arrest (OHCA) in men and women and to determine whether sex modifies the effect of targeted temperature management (TTM) at 33 or 36. °C. Methods: The TTM trial randomized 950 patients to TTM at 33 or 36. °C for 24. h. This predefined sub-study of the TTM trial assessed survival and neurological outcome defined as Cerebral Performance Category (CPC) and modified Rankin Scale (mRS) using female sex as main predictor of outcome, in relation to level of TTM and other confounding factors. Results: Compared to men, women more often had OHCA at home, p= 0.04 and less often had bystander defibrillation, p= 0.01. No other differences in arrest circumstances were found. Coronary angiography (CAG) and percutaneous coronary intervention (PCI) <24. h after ROSC was less often performed in women, both: p= 0.02.Female sex was associated with higher mortality in univariate analysis, hazard ratio (HR) = 1.29, CI = 1.04-1.61, p= 0.02 compared to men. Adjusting for demographic factors (age and comorbidity), arrest circumstances, pre-hospital findings, inclusion sites, treatments and status at admission reduced this: HR = 1.11, CI = 0. 87-1.41, p= 0.42, and sex was no longer an independent risk factor for death. The effect of sex did not modify the effect of TTM at 33 and 36°C, pinteraction=0.73. Conclusion: Female sex seems associated with adverse outcome, but this association is largely explained by differences in arrest circumstances and in-hospital treatment. Our data shows no interaction between sex and the effect of targeting 33 vs. 36. °C.

U2 - 10.1016/j.resuscitation.2015.06.030

DO - 10.1016/j.resuscitation.2015.06.030

M3 - Journal article

C2 - 26215480

SN - 0300-9572

VL - 96

SP - 78

EP - 84

JO - Resuscitation

JF - Resuscitation

ER -

No difference in mortality between men and women after out-of-hospital cardiac arrest

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