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

Eva M Spoormans; Jorrit S Lemkes; Gladys N Janssens; Nina W van der Hoeven; Lucia S D Jewbali; Eric A Dubois; Peter M van de Ven; Martijn Meuwissen; Tom A Rijpstra; Hans A Bosker; Michiel J Blans; Gabe B Bleeker; Remon Baak; Georgios J Vlachojannis; Bob J W Eikemans; Pim van der Harst; Iwan C C van der Horst; Michiel Voskuil; Joris J van der Heijden; Albertus Beishuizen; Martin Stoel; Cyril Camaro; Hans van der Hoeven; José P Henriques; Alexander P J Vlaar; Maarten A Vink; Bas van den Bogaard; Ton A C M Heestermans; Wouter de Ruijter; Thijs S R Delnoij; Harry J G M Crijns; Gillian A J Jessurun; Pranobe V Oemrawsingh; Marcel T M Gosselink; Koos Plomp; Michael Magro; Paul W G Elbers; Yolande Appelman; Niels van Royen

doi:10.1016/j.resuscitation.2020.10.026

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

Eva M Spoormans, Jorrit S Lemkes, Gladys N Janssens, Nina W van der Hoeven, Lucia S D Jewbali, Eric A Dubois, Peter M van de Ven, Martijn Meuwissen, Tom A Rijpstra, Hans A Bosker, Michiel J Blans, Gabe B Bleeker, Remon Baak, Georgios J Vlachojannis, Bob J W Eikemans, Pim van der Harst, Iwan C C van der Horst, Michiel Voskuil, Joris J van der Heijden, Albertus BeishuizenMartin Stoel, Cyril Camaro, Hans van der Hoeven, José P Henriques, Alexander P J Vlaar, Maarten A Vink, Bas van den Bogaard, Ton A C M Heestermans, Wouter de Ruijter, Thijs S R Delnoij, Harry J G M Crijns, Gillian A J Jessurun, Pranobe V Oemrawsingh, Marcel T M Gosselink, Koos Plomp, Michael Magro, Paul W G Elbers, Yolande Appelman, Niels van Royen

Research output: Contribution to journal › Article › Academic › peer-review

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 1.31–7.19;p = 0.01). This was not the case for men (HR 1.05; 95% CI 0.67–1.65;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 0.58–1.30;p = 0.49; vs. men, OR 0.97; 95% CI 0.45–2.09;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.

Original language	English
Pages (from-to)	14-22
Number of pages	9
Journal	Resuscitation
Volume	158
DOIs	https://doi.org/10.1016/j.resuscitation.2020.10.026
Publication status	Published - Jan 2021

Keywords

coronary angiography
differences
out-of-hospital cardiac arrest
sex

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10.1016/j.resuscitation.2020.10.026

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Spoormans, E. M., Lemkes, J. S., Janssens, G. N., van der Hoeven, N. W., Jewbali, L. S. D., Dubois, E. A., van de Ven, P. M., Meuwissen, M., Rijpstra, T. A., Bosker, H. A., Blans, M. J., Bleeker, G. B., Baak, R., Vlachojannis, G. J., Eikemans, B. J. W., der Harst, P. V., van der Horst, I. C. C., Voskuil, M., van der Heijden, J. J., ... van Royen, N. (2021). Sex differences in patients with out-of-hospital cardiac arrest without ST-segment elevation: A COACT trial substudy. Resuscitation, 158, 14-22. https://doi.org/10.1016/j.resuscitation.2020.10.026

@article{a472daf19ecd48f7942889b4fecf2e8d,

title = "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 1.31–7.19;p = 0.01). This was not the case for men (HR 1.05; 95% CI 0.67–1.65;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 0.58–1.30;p = 0.49; vs. men, OR 0.97; 95% CI 0.45–2.09;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.",

keywords = "coronary angiography, differences, out-of-hospital cardiac arrest, sex",

author = "Spoormans, {Eva M} and Lemkes, {Jorrit S} and Janssens, {Gladys N} and {van der Hoeven}, {Nina W} and Jewbali, {Lucia S D} and Dubois, {Eric A} and {van de Ven}, {Peter M} and Martijn Meuwissen and Rijpstra, {Tom A} and Bosker, {Hans A} and Blans, {Michiel J} and Bleeker, {Gabe B} and Remon Baak and Vlachojannis, {Georgios J} and Eikemans, {Bob J W} and {der Harst}, {Pim van} and {van der Horst}, {Iwan C C} and Michiel Voskuil and {van der Heijden}, {Joris J} and Albertus Beishuizen and Martin Stoel and Cyril Camaro and {van der Hoeven}, Hans and Henriques, {Jos{\'e} P} and Vlaar, {Alexander P J} and Vink, {Maarten A} and {van den Bogaard}, Bas and Heestermans, {Ton A C M} and {de Ruijter}, Wouter and Delnoij, {Thijs S R} and Crijns, {Harry J G M} and Jessurun, {Gillian A J} and Oemrawsingh, {Pranobe V} and Gosselink, {Marcel T M} and Koos Plomp and Michael Magro and Elbers, {Paul W G} and Yolande Appelman and {van Royen}, Niels",

note = "Funding Information: Supported by unrestricted research grants from the Netherlands Heart Institute, Biotronik, and AstraZeneca. Publisher Copyright: {\textcopyright} 2020",

year = "2021",

month = jan,

doi = "10.1016/j.resuscitation.2020.10.026",

language = "English",

volume = "158",

pages = "14--22",

journal = "Resuscitation",

issn = "0300-9572",

publisher = "Elsevier Ireland Ltd",

}

Spoormans, EM, Lemkes, JS, Janssens, GN, van der Hoeven, NW, Jewbali, LSD, Dubois, EA, van de Ven, PM, Meuwissen, M, Rijpstra, TA, Bosker, HA, Blans, MJ, Bleeker, GB, Baak, R, Vlachojannis, GJ, Eikemans, BJW, der Harst, PV, van der Horst, ICC, Voskuil, M, van der Heijden, JJ, Beishuizen, A, Stoel, M, Camaro, C, van der Hoeven, H, Henriques, JP, Vlaar, APJ, Vink, MA, van den Bogaard, B, Heestermans, TACM, de Ruijter, W, Delnoij, TSR, Crijns, HJGM, Jessurun, GAJ, Oemrawsingh, PV, Gosselink, MTM, Plomp, K, Magro, M, Elbers, PWG, Appelman, Y & van Royen, N 2021, 'Sex differences in patients with out-of-hospital cardiac arrest without ST-segment elevation: A COACT trial substudy', Resuscitation, vol. 158, pp. 14-22. https://doi.org/10.1016/j.resuscitation.2020.10.026

TY - JOUR

T1 - Sex differences in patients with out-of-hospital cardiac arrest without ST-segment elevation

T2 - A COACT trial substudy

AU - Spoormans, Eva M

AU - Lemkes, Jorrit S

AU - Janssens, Gladys N

AU - van der Hoeven, Nina W

AU - Jewbali, Lucia S D

AU - Dubois, Eric A

AU - van de Ven, Peter M

AU - Meuwissen, Martijn

AU - Rijpstra, Tom A

AU - Bosker, Hans A

AU - Blans, Michiel J

AU - Bleeker, Gabe B

AU - Baak, Remon

AU - Vlachojannis, Georgios J

AU - Eikemans, Bob J W

AU - der Harst, Pim van

AU - van der Horst, Iwan C C

AU - Voskuil, Michiel

AU - van der Heijden, Joris J

AU - Beishuizen, Albertus

AU - Stoel, Martin

AU - Camaro, Cyril

AU - van der Hoeven, Hans

AU - Henriques, José P

AU - Vlaar, Alexander P J

AU - Vink, Maarten A

AU - van den Bogaard, Bas

AU - Heestermans, Ton A C M

AU - de Ruijter, Wouter

AU - Delnoij, Thijs S R

AU - Crijns, Harry J G M

AU - Jessurun, Gillian A J

AU - Oemrawsingh, Pranobe V

AU - Gosselink, Marcel T M

AU - Plomp, Koos

AU - Magro, Michael

AU - Elbers, Paul W G

AU - Appelman, Yolande

AU - van Royen, Niels

PY - 2021/1

Y1 - 2021/1

N2 - 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 1.31–7.19;p = 0.01). This was not the case for men (HR 1.05; 95% CI 0.67–1.65;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 0.58–1.30;p = 0.49; vs. men, OR 0.97; 95% CI 0.45–2.09;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.

AB - 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 1.31–7.19;p = 0.01). This was not the case for men (HR 1.05; 95% CI 0.67–1.65;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 0.58–1.30;p = 0.49; vs. men, OR 0.97; 95% CI 0.45–2.09;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.

KW - coronary angiography

KW - differences

KW - out-of-hospital cardiac arrest

KW - sex

UR - http://www.scopus.com/inward/record.url?scp=85097236640&partnerID=8YFLogxK

U2 - 10.1016/j.resuscitation.2020.10.026

DO - 10.1016/j.resuscitation.2020.10.026

M3 - Article

C2 - 33189807

SN - 0300-9572

VL - 158

SP - 14

EP - 22

JO - Resuscitation

JF - Resuscitation

ER -

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

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Keywords

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