Key result
Refractory ventricular arrhythmias in out-of-hospital cardiac arrest were associated with significantly lower 30-day survival (OR 0.25) compared to non-refractory arrhythmias, with a particularly poor prognosis in males linked to pre-existing coronary artery disease.
Why the study?
Data were limited on sex-related differences in out-of-hospital cardiac arrests with refractory ventricular arrhythmias, particularly regarding cardiovascular risk profiles and coronary artery disease severity.
Does refractory ventricular arrhythmia impact survival in out-of-hospital cardiac arrest patients with a first shockable rhythm, and are there sex-related differences?
Observational (n=680)
Yes
Does refractory ventricular arrhythmia impact survival in out-of-hospital cardiac arrest patients with a first shockable rhythm, and are there sex-related differences?
Refractory ventricular arrhythmias in out-of-hospital cardiac arrest are more common in men and associated with pre-existing coronary artery disease and worse survival, whereas they are rare in women and not associated with worse outcomes.
Answers are grounded in this paper and cite their sources.
May identify high-risk males for intensified monitoring; hypothesis-generating for sex-specific strategies in refractory OHCA.
Introduction There are limited data on sex-related differences in out-of hospital cardiac arrests (OHCAs) with refractory ventricular arrhythmias (VA) and, in particular, about their relationship with cardiovascular risk profile and severity of coronary artery disease (CAD). Purpose Aim of this study was to characterize sex-related differences in clinical presentation, cardiovascular risk profile, CAD prevalence, and outcome in OHCA victims presenting with refractory VA. Methods All OHCAs with shockable rhythm that occurred between 2015 and 2019 in the province of Pavia (Italy) and in the Canton Ticino (Switzerland) were included. Results Out of 680 OHCAs with first shockable rhythm, 216 (33%) had a refractory VA. OHCA patients with refractory VA were younger and more often male. Males with refractory VA had more often a history of CAD (37% vs. 21%, p 0.03). In females, refractory VA were less frequent (M : F ratio 5 : 1) and no significant differences in cardiovascular risk factor prevalence or clinical presentation were observed. Male patients with refractory VA had a significantly lower survival at hospital admission and at 30 days as compared to males without refractory VA (45% vs. 64%, p < 0.001 and 24% vs. 49%, p < 0.001, respectively). Whereas in females, no significant survival difference was observed. Conclusions In OHCA patients presenting with refractory VA the prognosis was significantly poorer for male patients. The refractoriness of arrhythmic events in the male population was probably due to a more complex cardiovascular profile and in particular due to a pre-existing CAD. In females, OHCA with refractory VA were less frequent and no correlation with a specific cardiovascular risk profile was observed.
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Caputo et al. (2023) conducted an observational in Out-of-hospital cardiac arrest with shockable rhythm (n=680). Refractory ventricular arrhythmias vs. Non-refractory ventricular arrhythmias was evaluated on 30-day survival (OR 0.25, 95% CI 0.22-0.27, p=<0.001). Refractory ventricular arrhythmias in out-of-hospital cardiac arrest were associated with significantly lower 30-day survival (OR 0.25) compared to non-refractory arrhythmias, with a particularly poor prognosis in males linked to pre-existing coronary artery disease.
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