Sex disparities in management and outcomes of cardiac arrest complicating acute myocardial infarction in the United States

• DOI: 10.1016/j.resuscitation.2022.01.024
• Publication Date: 2022-01-31T13:37:21Z
• Authors: Dhiran Verghese; Sri Harsha Patlolla; Wisit Cheungpasit...; Rajkumar Doshi; Virginia M. Miller; Jacob C. Jentzer; Allan S. Jaffe; David R. Holmes; Saraschandra Vall...
• Keywords: Adult; Male; Myocardial Infarction; Shock, Cardiogenic; United States; 3. Good health; Heart Arrest; 03 medical and health sciences; Percutaneous Coronary Intervention; 0302 clinical medicine; Humans; Female; Hospital Mortality; 10. No inequality

There have been limited large scale studies assessing sex disparities in the outcomes of cardiac arrest (CA) complicating acute myocardial infarction (AMI).Using the National Inpatient Sample (2000-2017), we identified adult admissions (≥18 years) with AMI and CA. Outcomes of interest included sex disparities in coronary angiography (early [hospital day zero] and overall), time to angiography, percutaneous coronary angiography (PCI), mechanical circulatory support (MCS) use, in-hospital mortality, hospitalization costs, hospital length of stay and discharge disposition. In the period between January 1, 2000-December 31, 2017, 11,622,528 admissions for AMI were identified, of which 584,216 (5.0%) were complicated by CA. Men had a higher frequency of CA compared to women (5.4% vs. 4.4%; p < 0.001). Women were on average older (70.4 ± 13.6 vs 65.0 ± 13.1 years), of black race (12.6% vs 7.9%), with higher comorbidity, presenting with non-ST-segment-elevation AMI (36.4% vs 32.3%) and had a non-shockable rhythm (47.6% vs 33.3%); all p < 0.001. Women received less frequent coronary angiography (56.0% vs 66.2%), early coronary angiography (32.0% vs 40.2%), PCI (40.4% vs 49.7%), MCS (17.6% vs 22.0%), and CABG (8.3% vs 10.8%), with a longer median time to angiography (all p < 0.001). Women had higher in-hospital mortality (52.6% vs 40.6%, adjusted odds ratio 1.13 [95% confidence interval 1.11-1.14]; p < 0.001), shorter length of hospital stays, lower hospitalization costs and less frequent discharges to home.Despite no difference in guideline recommendations for men and women with AMI-CA, there appears to be a systematic difference in the use of evidence-based care that disadvantages women.