Sex Disparities in Coronary Angiography Findings of Out-of-Hospital Cardiac Arrest Complicating Acute Coronary Syndromes

OBJECTIVES: Sex-based disparities have been widely reported in the management and outcomes of out-of-hospital cardiac arrest (OHCA), often complicating acute coronary syndromes (ACS). While previous studies have demonstrated that female patients are less likely to undergo invasive coronary angiography (ICA) or percutaneous coronary intervention (PCI), little is known about potential differences in coronary anatomy or PCI strategies in this context. The authors sought to evaluate sex-related differences in ICA findings and PCI management among OHCA survivors with angiographically confirmed ACS. METHODS: The authors conducted a retrospective, single-center study including consecutive OHCA patients admitted to the intensive care unit of a tertiary center between 2007 and 2024 who underwent emergent PCI. Propensity score matching was used to compare female and male based on key baseline characteristics. Coronary lesion characteristics, procedural data, and clinical outcomes were analyzed. RESULTS: Among 486 patients (mean age 60.6 ± 12.2 years), 105 (21.6%) were female patients. After matching, 210 patients (105 female, 105 male) were included. No significant differences were observed in the extent of coronary artery disease, lesion complexity, or PCI strategies. Female patients had more frequent right coronary artery culprit lesions and less left circumflex involvement. Thrombus aspiration was more common in female patients (33.3% vs 21.0%, P = .04). Adjusted in-hospital and 3-month mortality rates were not significantly different. CONCLUSIONS: In OHCA survivors with ACS undergoing PCI, females and males had similar angiographic profiles and PCI approaches. These findings suggest that coronary and procedural factors do not explain sex-based differences in OHCA outcomes, underlining the need for equitable access to early invasive management.