Women Are Less Likely to Survive AMI Presenting With Out-of-Hospital Cardiac Arrest: A Nationwide Study |
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| Affiliation: | 1. Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke-on-Trent, UK;2. Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK;3. Population Health Research Institute, Hamilton, Ontario, Canada;4. Department of Medicine and Department of Health Research, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada;5. Division of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA;6. Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA;7. Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA;8. Deborah Heart and Lung Center, Browns Mill, NJ, USA;9. Division of Cardiology, Rush Medical College, Rush University, Chicago, IL, USA;10. Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA;1. Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom;2. Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom;3. Human Performance Lab, Education, Physical Activity and Health Research Unit, University Católica del Maule, Talca, Chile;1. Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University) and National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China;2. Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden;1. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY;2. Division of General Medicine, Columbia University Irving Medical Center, New York, NY;3. John Ochsner Heart and Vascular Institute, Ochsner Clinical School–University of Queensland School of Medicine, New Orleans, LA;1. Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA;2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;3. Department of Nephrology, Graduate School of Medicine, Nagoya University, Nagoya, Japan;4. Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD;5. Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC;6. Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA;1. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN;2. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN;3. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN;4. OptumLabs, Cambridge, MA |
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| Abstract: | ObjectiveTo 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 MethodsWe 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.ResultsOf 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).ConclusionWomen 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. |
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