Coronary angiography and reperfusion therapy following out-of-hospital cardiac arrest in women

Introduction Survival after out-of-hospital cardiac arrest is lower in women than in men, often attributed to older age, more comorbidities and non-shockable rhythms at presentation. Coronary angiography and reperfusion therapy are cornerstones in post-cardiac arrest care yet appear to be used less often in women. Data on coronary artery disease among patients presenting with non-shockable rhythms and no ST-segment elevation remain limited. Methods We conducted a nationwide cohort study including all out-of-hospital cardiac arrest patients admitted alive to Swedish hospitals between 2010 and 2019. Adjusted odds ratios (OR) of coronary angiography and percutaneous coronary intervention during hospitalization were calculated for women compared with men, controlling for age, comorbidities, and initial rhythm. Sex-specific angiographic findings were examined in patients without shockable rhythm or ST-segment elevation. Results Of 8,641 patients, 29.4% were women. Coronary angiography was performed in 31.5% of women versus 51.0% of men. Women were less likely to undergo coronary angiography (OR 0.77, 95% CI 0.66–0.90) and percutaneous coronary intervention (OR 0.76, 95% CI 0.64-0.90). After adjusting for angiographic findings, intervention rates were similar between sexes (OR 0.97, 95% CI 0.80-1.18). Among angiographed patients with non-shockable rhythms and no ST-elevation, significant coronary artery disease was found in 31% of women and 53% of men. Conclusion Women with resuscitated out-of-hospital cardiac arrest were less likely to undergo coronary angiography yet had similar rates of percutaneous coronary intervention when obstructive coronary artery disease was present. In patients without an initial shockable rhythm or ST-segment elevation, many had significant coronary artery disease.