Sex disparities in management and outcomes of cardiac arrest complicating acute myocardial infarction in the United States

Dhiran Verghese, Sri Harsha Patlolla, Wisit Cheungpasitporn, Rajkumar Doshi, Virginia M. Miller, Jacob C. Jentzer, Allan S. Jaffe, David R. Holmes, Saraschandra Vallabhajosyula

Research output: Contribution to journalArticlepeer-review


Background: There have been limited large scale studies assessing sex disparities in the outcomes of cardiac arrest (CA) complicating acute myocardial infarction (AMI). Methods and results: Using the National Inpatient Sample (2000–2017), we identified adult admissions (≥18 years) with AMI and CA. Outcomes of interest included sex disparities in coronary angiography (early [hospital day zero] and overall), time to angiography, percutaneous coronary angiography (PCI), mechanical circulatory support (MCS) use, in-hospital mortality, hospitalization costs, hospital length of stay and discharge disposition. In the period between January 1, 2000-December 31, 2017, 11,622,528 admissions for AMI were identified, of which 584,216 (5.0%) were complicated by CA. Men had a higher frequency of CA compared to women (5.4% vs. 4.4%; p < 0.001). Women were on average older (70.4 ± 13.6 vs 65.0 ± 13.1 years), of black race (12.6% vs 7.9%), with higher comorbidity, presenting with non-ST-segment-elevation AMI (36.4% vs 32.3%) and had a non-shockable rhythm (47.6% vs 33.3%); all p < 0.001. Women received less frequent coronary angiography (56.0% vs 66.2%), early coronary angiography (32.0% vs 40.2%), PCI (40.4% vs 49.7%), MCS (17.6% vs 22.0%), and CABG (8.3% vs 10.8%), with a longer median time to angiography (all p < 0.001). Women had higher in-hospital mortality (52.6% vs 40.6%, adjusted odds ratio 1.13 [95% confidence interval 1.11–1.14]; p < 0.001), shorter length of hospital stays, lower hospitalization costs and less frequent discharges to home. Conclusion: Despite no difference in guideline recommendations for men and women with AMI-CA, there appears to be a systematic difference in the use of evidence-based care that disadvantages women.

Original languageEnglish (US)
Pages (from-to)92-100
Number of pages9
StatePublished - Mar 2022


  • Acute myocardial infarction
  • Cardiac arrest
  • Complications
  • Female sex
  • Healthcare disparities
  • Outcomes research

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine


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