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Women Are Less Likely to Survive AMI Presenting With Out-of-Hospital Cardiac Arrest

A Nationwide Study

      Abstract

      Objective

      To assess the impact of patient’s sex on outcomes and management of acute myocardial infarction (AMI) patients presenting with out-of-hospital cardiac arrest (OHCA).

      Patients and Methods

      We conducted a population-based retrospective cohort study in AMI patients admitted with OHCA between 2010 and 2017 from the Myocardial Ischaemia National Audit Project (MINAP) registry. We used multivariable logistic regression models to evaluate the role of sex as a predictor of clinical outcomes and treatment strategy.

      Results

      Of 16,278 patients, women constituted almost one-quarter of the population (n=3710 [22.7%]). Women were older (median age 69 [IQR, 57-79] years vs 63 [IQR, 54-72] years, P<.001), experienced longer call-to-hospital-arrival time (median, 1.2 hours vs 1.1 hours; P=.008), were less likely to present with shockable rhythm (86.8% vs 91.5%, P<.001), and less likely to receive dual antiplatelet therapy (73.8% vs 78.6%, P<.001), beta blockers (64.7% vs 72.3%, P<.001), angiotensin-converting enzyme inhibitors (49.0% vs 55.3%, P<.001), coronary angiography (73.7% vs 83.3%, P<.001), and percutaneous coronary intervention (37.5% vs. 40.7%, p 0.004). After adjusting for patient characteristics and management, women had significantly higher odds of in-hospital death compared with men (odds ratio [OR], 1.3; 95% CI, 1.1 to 1.5) and lower odds of receiving coronary angiography (OR, 0.67; 95% CI, 0.59 to 0.75) and coronary artery bypass graft (OR, 0.28; 95% CI, 0.19 to 0.40).

      Conclusion

      Women were less likely to survive following OHCA secondary to AMI. Hospital protocols that minimize physician bias and improve women-physician communication are needed to close this gap.

      Graphical abstract

      Abbreviations and Acronyms:

      ACEI (angiotensin-converting enzyme inhibitors), AMI (acute myocardial infarction), CABG (coronary artery bypass graft), COPD (chronic obstructive pulmonary disease), LV (left ventricle), MICE (multiple imputation techniques using chained equations), MINAP (the Myocardial Ischemia National Audit Project), NHS (National Health Service), NSTEMI (non–ST-segment myocardial infarction), OHCA (out-of-hospital cardiac arrest), PCI (percutaneous coronary intervention), ROSC (restoration of spontaneous circulation), STEMI (ST-segment myocardial infarction)
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      Linked Article

      • Even When the Heart Stops, the Sex Differences Remain
        Mayo Clinic ProceedingsVol. 97Issue 9
        • Preview
          Cardiovascular disease remains the leading cause of death in women,1 but mechanisms of sex-related differences that affect many facets of cardiovascular disease remain underrecognized and poorly understood. Men historically have been disproportionately represented in clinical studies, and consequently, guidelines have been built on data that are predominantly applicable to men.1 There has recently been an increasing commitment to better understand sex-related differences that affect the epidemiology, presentation, diagnosis, treatment, and outcomes of cardiovascular disease.
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