• Mayo Clinic proceedings · Sep 2022

    Women Are Less Likely to Survive AMI Presenting With Out-of-Hospital Cardiac Arrest: A Nationwide Study.

    • Mohamed Dafaalla, Muhammad Rashid, Van SpallHarriette G CHGCPopulation Health Research Institute, Hamilton, Ontario, Canada; Department of Medicine and Department of Health Research, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada., Laxmi Mehta, Purvi Parwani, Garima Sharma, Renee Bullock Palmer, Saadiq Moledina, Annabelle Santos Volgman, and Mamas A Mamas.
    • Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke-on-Trent, UK; Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK.
    • Mayo Clin. Proc. 2022 Sep 1; 97 (9): 1608-1618.

    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.Copyright © 2022 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

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