Gender disparities in percutaneous coronary intervention in out-of-hospital cardiac arrest

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Abstract

Background: Quality of post-arrest care is considered a significant factor for overall survival and neurological outcomes in out-of-hospital cardiac arrest (OHCA). However, previous studies suggested gender differences in invasive treatments including percutaneous coronary intervention (PCI). In this study, we evaluated gender disparities in the delivery of PCI among OHCA patients. Methods: All adults OHCA patients with presumed cardiac etiology and sustained ROSC between 2013 and 2016 were included in the study. Main exposure was gender and primary outcome was PCI treatment. Multivariable logistic regression was used to analyze the association between gender and PCI treatment, adjusting for patient, community, prehospital, and hospital factors. The time interval from return of spontaneous circulation (ROSC) to PCI and survival outcomes were also analyzed as secondary and tertiary outcomes. Results: A total of 20,675 patients were included for final analysis. Multivariable analysis showed that female patients were significantly less likely to receive PCI compared to males with adjusted odds ratio (OR) of 0.40 (95% CI 0.30–0.53). However, among those who received PCI, there were no significant associations between gender and time from ROSC to PCI (≤90 vs. >90 min). Overall survival outcomes were not significantly associated with gender after adjusting for PCI and other confounding factors (OR = 0.87, 95% CI 0.71–1.08 for survival to discharge and OR = 0.87, 95% CI 0.70–1.08 for good neurological recovery). Conclusions: Among sustained ROSC patients following OHCA, female patients were significantly less likely to undergo PCI than males. Further studies are warranted to reduce gender disparities in caring for post-arrest patients.

Original languageEnglish
Pages (from-to)632-638
Number of pages7
JournalAmerican Journal of Emergency Medicine
Volume37
Issue number4
DOIs
StatePublished - Apr 2019

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Out-of-Hospital Cardiac Arrest
Percutaneous Coronary Intervention
Survival
Odds Ratio
Community Hospital
Therapeutics
Logistic Models

Keywords

  • Gender disparity
  • Out-of-hospital cardiac arrest
  • Percutaneous coronary intervention
  • Post-resuscitation treatment

Cite this

@article{751ea09d1c3b4438949271db8a56dfb3,
title = "Gender disparities in percutaneous coronary intervention in out-of-hospital cardiac arrest",
abstract = "Background: Quality of post-arrest care is considered a significant factor for overall survival and neurological outcomes in out-of-hospital cardiac arrest (OHCA). However, previous studies suggested gender differences in invasive treatments including percutaneous coronary intervention (PCI). In this study, we evaluated gender disparities in the delivery of PCI among OHCA patients. Methods: All adults OHCA patients with presumed cardiac etiology and sustained ROSC between 2013 and 2016 were included in the study. Main exposure was gender and primary outcome was PCI treatment. Multivariable logistic regression was used to analyze the association between gender and PCI treatment, adjusting for patient, community, prehospital, and hospital factors. The time interval from return of spontaneous circulation (ROSC) to PCI and survival outcomes were also analyzed as secondary and tertiary outcomes. Results: A total of 20,675 patients were included for final analysis. Multivariable analysis showed that female patients were significantly less likely to receive PCI compared to males with adjusted odds ratio (OR) of 0.40 (95{\%} CI 0.30–0.53). However, among those who received PCI, there were no significant associations between gender and time from ROSC to PCI (≤90 vs. >90 min). Overall survival outcomes were not significantly associated with gender after adjusting for PCI and other confounding factors (OR = 0.87, 95{\%} CI 0.71–1.08 for survival to discharge and OR = 0.87, 95{\%} CI 0.70–1.08 for good neurological recovery). Conclusions: Among sustained ROSC patients following OHCA, female patients were significantly less likely to undergo PCI than males. Further studies are warranted to reduce gender disparities in caring for post-arrest patients.",
keywords = "Gender disparity, Out-of-hospital cardiac arrest, Percutaneous coronary intervention, Post-resuscitation treatment",
author = "Jeong, {Jin Seop} and Kong, {So Yeon} and Shin, {Sang Do} and Ro, {Young Sun} and Song, {Kyoung Jun} and Hong, {Ki Jeong} and Park, {Jeong Ho} and Kim, {Tae Han}",
year = "2019",
month = "4",
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language = "English",
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pages = "632--638",
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TY - JOUR

T1 - Gender disparities in percutaneous coronary intervention in out-of-hospital cardiac arrest

AU - Jeong, Jin Seop

AU - Kong, So Yeon

AU - Shin, Sang Do

AU - Ro, Young Sun

AU - Song, Kyoung Jun

AU - Hong, Ki Jeong

AU - Park, Jeong Ho

AU - Kim, Tae Han

PY - 2019/4

Y1 - 2019/4

N2 - Background: Quality of post-arrest care is considered a significant factor for overall survival and neurological outcomes in out-of-hospital cardiac arrest (OHCA). However, previous studies suggested gender differences in invasive treatments including percutaneous coronary intervention (PCI). In this study, we evaluated gender disparities in the delivery of PCI among OHCA patients. Methods: All adults OHCA patients with presumed cardiac etiology and sustained ROSC between 2013 and 2016 were included in the study. Main exposure was gender and primary outcome was PCI treatment. Multivariable logistic regression was used to analyze the association between gender and PCI treatment, adjusting for patient, community, prehospital, and hospital factors. The time interval from return of spontaneous circulation (ROSC) to PCI and survival outcomes were also analyzed as secondary and tertiary outcomes. Results: A total of 20,675 patients were included for final analysis. Multivariable analysis showed that female patients were significantly less likely to receive PCI compared to males with adjusted odds ratio (OR) of 0.40 (95% CI 0.30–0.53). However, among those who received PCI, there were no significant associations between gender and time from ROSC to PCI (≤90 vs. >90 min). Overall survival outcomes were not significantly associated with gender after adjusting for PCI and other confounding factors (OR = 0.87, 95% CI 0.71–1.08 for survival to discharge and OR = 0.87, 95% CI 0.70–1.08 for good neurological recovery). Conclusions: Among sustained ROSC patients following OHCA, female patients were significantly less likely to undergo PCI than males. Further studies are warranted to reduce gender disparities in caring for post-arrest patients.

AB - Background: Quality of post-arrest care is considered a significant factor for overall survival and neurological outcomes in out-of-hospital cardiac arrest (OHCA). However, previous studies suggested gender differences in invasive treatments including percutaneous coronary intervention (PCI). In this study, we evaluated gender disparities in the delivery of PCI among OHCA patients. Methods: All adults OHCA patients with presumed cardiac etiology and sustained ROSC between 2013 and 2016 were included in the study. Main exposure was gender and primary outcome was PCI treatment. Multivariable logistic regression was used to analyze the association between gender and PCI treatment, adjusting for patient, community, prehospital, and hospital factors. The time interval from return of spontaneous circulation (ROSC) to PCI and survival outcomes were also analyzed as secondary and tertiary outcomes. Results: A total of 20,675 patients were included for final analysis. Multivariable analysis showed that female patients were significantly less likely to receive PCI compared to males with adjusted odds ratio (OR) of 0.40 (95% CI 0.30–0.53). However, among those who received PCI, there were no significant associations between gender and time from ROSC to PCI (≤90 vs. >90 min). Overall survival outcomes were not significantly associated with gender after adjusting for PCI and other confounding factors (OR = 0.87, 95% CI 0.71–1.08 for survival to discharge and OR = 0.87, 95% CI 0.70–1.08 for good neurological recovery). Conclusions: Among sustained ROSC patients following OHCA, female patients were significantly less likely to undergo PCI than males. Further studies are warranted to reduce gender disparities in caring for post-arrest patients.

KW - Gender disparity

KW - Out-of-hospital cardiac arrest

KW - Percutaneous coronary intervention

KW - Post-resuscitation treatment

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