Clinical paperGender differences in early invasive strategy after cardiac arrest: Insights from the PROCAT registry☆
Introduction
Out-of-hospital cardiac arrest (OHCA) is a major public health concern, with 200,000–300,000 cases reported annually in the United States,1, 2 or in Europe.3 Survival rates remain low,4 but recent data suggest that outcome improved.5 This improvement is mainly attributable to higher prehospital survival rates,6 but might be also due to post-resuscitation care. Thus, early invasive strategy (coronary angiogram (CAG) and percutaneous coronary intervention (PCI)) is associated with an improvement in both short and long-term outcomes in OHCA patients.7, 8
Selection of the best candidates for an early invasive strategy is still debated. By analogy with acute coronary syndromes, gender could influence the management of these patients and particularly the decision for CAG. Important differences have been reported between men and women in management of myocardial infarction.9, 10 Accordingly, an enhanced survival benefit from restoring myocardial perfusion for women compared with men during primary angioplasty has been reported.11 In the field of OHCA, several gender specificities have been identified,12, 13, 14, 15, 16 but to the best of our knowledge, no data regarding gender differences in the coronary management of survivors of OHCA are available, and studies leading to current guidelines mainly included men.7, 8 The need for specific gender-studies has been recently emphasized.17 Highlighting gender differences in coronary management of OHCA could lead to specific recommendations for women, and therapeutic strategies could differ according to gender.
We used the large prospective PROCAT (Parisian Registry out-of-hospital cardiac arrest) registry in order to assess the relationship between an early invasive strategy and outcome according to gender in patients admitted after OHCA
Section snippets
Study setting
In Paris (France), management of OHCA involves mobile emergency units and fire departments.18 They cover a population of approximately 6.6 million during the day and 2.5 million at night. Upon witnessed call and in suspected cases of OHCA, the closest emergency unit is dispatched on the scene. Out-of-hospital resuscitation is delivered by an emergency team, which includes at least one trained physician in emergency medicine according to the international guidelines.19 Patients in whom return of
Population characteristics
From January 2000 to December 2013, 1817 patients with OHCA were included (Fig. 1). Baseline characteristics of patients according to gender are presented in Table 1. Women were older (62.8 vs 59.1 years, P < 0.0001), with less cardiomyopathy and less cardiovascular risk factors. Women had less initial shockable rhythm (42% vs 61%, P < 0.001) and had more post-OHCA shock. Post-resuscitation ECG found ST-elevation more often among men than women (21% vs 13%, P < 0.001). Women were more likely to have
Discussion
In this study, we reported the use and outcome of early invasive strategy for patients admitted after OHCA according to gender. First, after adjustment and matching on baseline characteristics, women were less likely to undergo early invasive strategy after OHCA but this did not result in a higher rate of missed ischemic diagnosis. Second, when an early invasive strategy was employed, women and men had the same rate of PCI. Finally, association between early invasive strategy and favorable
Conclusion
After resuscitated OHCA, women are less likely to undergo early invasive strategy, due to a less agressive approach. However, rates of PCI after early invasive strategy and association between PCI and favorable outcome are similar in men and women. Hence, women should receive the same standard of care as men after OHCA.
Conflicts of interest statement
None.
Sources of funding
None.
Acknowledgment
None.
References (40)
- et al.
Incidence of EMS-treated out-of-hospital cardiac arrest in the United States
Resuscitation
(2004) - et al.
Incidence of EMS-treated out-of-hospital cardiac arrest in Europe
Resuscitation
(2005) - et al.
European Resuscitation Council and European Society of Intensive Care Medicine guidelines for post-resuscitation care 2015: section 5 of the European Resuscitation Council guidelines for resuscitation 2015
Resuscitation
(2015) - et al.
Implications of myocardial reperfusion on survival in women versus men with acute myocardial infarction undergoing primary coronary intervention
Am J Cardiol
(2013) - et al.
Gender and survival after sudden cardiac arrest: a systematic review and meta-analysis
Resuscitation
(2015) - et al.
Exploring gender differences and the oestrogen effect in an Australian out-of-hospital cardiac arrest population
Resuscitation
(2013) - et al.
Survival after out-of-hospital cardiac arrest in relation to sex: a nationwide registry-based study
Resuscitation
(2014) Cardiovascular disease in women–often silent and fatal
Lancet
(2011)- et al.
International EMS systems: France
Resuscitation
(2004) - et al.
Benefit of an early and systematic imaging procedure after cardiac arrest: insights from the PROCAT (Parisian Region out of hospital cardiac arrest) registry
Resuscitation
(2012)
Assessment of outcome after severe brain damage
Lancet
European Resuscitation Council guidelines for resuscitation 2010 section 4: adult advanced life support
Resuscitation
No difference in mortality between men and women after out-of-hospital cardiac arrest
Resuscitation
Acute coronary angiographic findings in survivors of out-of-hospital cardiac arrest
Am Heart J
Women have a lower prevalence of structural heart disease as a precursor to sudden cardiac arrest: the Ore-SUDS (Oregon Sudden Unexpected Death Study)
J Am Coll Cardiol
Is female sex associated with increased survival after out-of-hospital cardiac arrest?
Resuscitation
Is there a difference between women and men in characteristics and outcome after in hospital cardiac arrest?
Resuscitation
Sudden cardiac death prediction and prevention: report from a National Heart, Lung, and Blood Institute and Heart Rhythm Society Workshop
Circulation
Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis
Circ Cardiovasc Qual Outcomes
Recent trends in survival from out-of-hospital cardiac arrest in the United States
Circulation
Cited by (0)
- ☆
A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2017.02.005.