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

Abstract

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 1.31À7.19;p = 0.01). This was not the case for men (HR 1.05; 95% CI 0.67À1.65;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 0.58À1.30;p = 0.49; vs. men, OR 0.97; 95% CI 0.45À2.09;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.

Early versus delayed coronary angiography in patients with out-of-hospital cardiac arrest and no ST-segment elevation: a systematic review and meta-analysis of randomized controlled trials

“…This adds to the body of evidence of sex-based differences in outcomes after OHCA. Although women are less likely than men to develop coronary artery disease, and their severity of coronary artery disease is lower in OHCA [ 24 , 25 ], they have a greater risk of major adverse cardiovascular events following percutaneous coronary intervention than men [ 15 ]. Importantly, women made up only one-fourth of the trial population.…”

Timing and outcomes after coronary angiography following out of hospital cardiac arrest without sings of ST segment elevation myocardial infarction

“…Noncomatose studied cases, who have better prognosis than comatose studied cases & who will be evaluated in future DISCO-NO-COMA trial, are another OHCA cohort that has not been included in any of published RCTs. Early angiography can prevent progressive myocardial injury that causes rearrest in noncomatose population, whereas in comatose studied cases, who frequently pass away from neurologic injury or discontinuation of life-supporting treatments because of expected poor prognosis, & whose prognosis cannot change with coronary revascularization (7).…”