Sex differences in management and outcomes after out-of-hospital cardiac arrest with angiographically confirmed obstructive coronary artery disease

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Out-of-hospital cardiac arrest (OHCA) with angiographically confirmed obstructive coronary artery disease (n=580). Intervention: Male sex vs. Female sex. Primary outcome: 30-day survival (OR 0.75, 95% CI 0.39-1.41, p=0.37).

Klaudia Svitekova; Daniel Rob; Eliska Mockova; Petra Kaválková; Jan Pudil; Milan Dusík; Jaromir Macoun; Eva Svobodova; Jan Malík; Anna Valeriánová; Silvie Trhlikova; Jan Spicak; Jan Bělohlávek

doi:10.1016/j.resplu.2026.101490

September 14, 2026Resuscitation PlusOpen Access

Sex differences in management and outcomes after out-of-hospital cardiac arrest with angiographically confirmed obstructive coronary artery disease

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Key result

Male sex is not associated with improved 30-day survival after OHCA with obstructive CAD.

OR 0.75
95% CI 0.39-1.41
P=0.37
n=580

Figures

Why the study?

Previous studies reported sex-based disparities in care after OHCA, but large registry analyses with detailed coronary angiography data were limited.

Does male sex affect 30-day survival compared to female sex in adults with out-of-hospital cardiac arrest and angiographically confirmed obstructive coronary artery disease?

Key Points

To evaluate sex-based differences in clinical management, procedural success, and clinical outcomes among patients with angiographically confirmed obstructive coronary artery disease following out-of-hospital cardiac arrest.
Post hoc analysis of a prospective registry evaluating 580 consecutive adult patients (491 men and 89 women) admitted between 2012 and 2023 with out-of-hospital cardiac arrest and angiographically confirmed obstructive coronary artery disease (≥70% stenosis).
Assessed primary endpoint of 30-day survival and secondary endpoint of favourable neurological outcome at hospital discharge (Cerebral Performance Category 1–2) using multivariable logistic regression.
Thirty-day survival was 66.2% in women versus 61.5% in men (log-rank p = 0.33; absolute risk difference 4.7%, 95% CI −6.4% to 14.8%), with sex not independently associated with survival after multivariable adjustment (OR for men vs. women 0.75; 95% CI 0.39–1.41; p = 0.37).
Favourable neurological outcome occurred in 55.1% of women compared to 53.8% of men (p = 0.82; absolute risk difference 1.3%, 95% CI −9.9% to 12.1%).
Men more frequently had three-vessel disease (41.5% vs. 31.4%, p = 0.02), while rates of immediate percutaneous coronary intervention (85.3% women vs. 76.5% men, p = 0.07) and procedural success with TIMI 3 flow (89.5% vs. 84.6%, p = 0.51) did not differ significantly.

Study Design

Type

Cohort (n=580)

Multicenter

No

Structured PICO

Does male sex affect 30-day survival compared to female sex in adults with out-of-hospital cardiac arrest and angiographically confirmed obstructive coronary artery disease?

P

Population

580 adults with out-of-hospital cardiac arrest and angiographically confirmed obstructive CAD, median age 61, 15.3% female, treated at a single tertiary center in the Czech Republic and followed for 30 days.

E

Exposure

Male sex (exposure)

C

Comparator

Female sex

O

Outcome

30-day survivalhard clinical

Main Result

Odds Ratio: 0.75 (95% CI 0.39–1.41)

Absolute Event Rate: 61.5% vs 66.2%

p-value: p=0.37

Limitations

Selection for angiography depends on clinician judgement and conditions the cohort, potentially hiding disparities in the decision to perform angiography.
Post hoc analysis of a prospective registry with potential residual confounding by unmeasured variables.
Women represented a minority of the study population, which may limit statistical power to detect small sex-based differences.
Single-center study conducted in a specialized tertiary cardiac arrest center with high rates of coronary intervention, limiting generalizability.
Cohort was conditioned on the performance of coronary angiography, unable to evaluate disparities in the decision to perform angiography
Post hoc analysis of a prospective registry with possible residual confounding
Women represented a minority, limiting statistical power
Single-center specialized tertiary cardiac arrest center limits generalizability

Implication

When standardized post-arrest and invasive pathways are applied to OHCA patients with angiographically confirmed obstructive CAD, previously observed sex disparities in outcomes are absent, highlighting that underlying arrest etiology drives differences rather than sex itself.

Abstract

Background: Previous studies have reported sex-based disparities in care, often disadvantaging women. Large registry analyses are limited by incomplete characterization of out-of-hospital cardiac arrest OHCA aetiology and coronary angiography (CAG) findings. We aimed to evaluate sex differences in management and outcomes among patients with angiographically confirmed obstructive coronary artery disease (CAD) following OHCA. Methods: We performed a post hoc analysis of consecutive adult OHCA patients with angiographically confirmed obstructive CAD admitted between 2012 and 2023 using a prospective OHCA registry. Obstructive CAD was defined as ≥70% coronary stenosis identified by coronary angiography and considered the most likely cause of OHCA. The primary outcome of this analysis was 30-day survival. The secondary outcome was favourable neurological outcome at hospital discharge. Multivariable logistic regression was used to assess the independent association between sex and 30-day survival. Results: = 0.37). Conclusions: In this cohort of patients with angiographically confirmed obstructive CAD following OHCA, no statistically significant sex-related differences were observed in management, procedural success, 30-day survival, or neurological outcomes. Men exhibited more extensive CAD.

Discussion

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Cite This Study

Svitekova et al. (2026) conducted a cohort in Out-of-hospital cardiac arrest (OHCA) with angiographically confirmed obstructive coronary artery disease (n=580). Male sex vs. Female sex was evaluated on 30-day survival (OR 0.75, 95% CI 0.39-1.41, p=0.37). In patients with out-of-hospital cardiac arrest and angiographically confirmed obstructive CAD, male sex was not independently associated with 30-day survival compared to female sex (adjusted OR 0.75).

synapsesocial.com/papers/6ad0fd3315427f6a84040586 https://doi.org/10.1016/j.resplu.2026.101490

Topics

Coronary artery disease

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Sex differences in management and outcomes after out-of-hospital cardiac arrest with angiographically confirmed obstructive coronary artery disease

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Sex differences in management and outcomes after out-of-hospital cardiac arrest with angiographically confirmed obstructive coronary artery disease

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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