TY - JOUR
T1 - Sex disparities in management and outcomes of cardiac arrest complicating acute myocardial infarction in the United States
AU - Verghese, Dhiran
AU - Patlolla, Sri Harsha
AU - Cheungpasitporn, Wisit
AU - Doshi, Rajkumar
AU - Miller, Virginia M.
AU - Jentzer, Jacob C.
AU - Jaffe, Allan S.
AU - Holmes, David R.
AU - Vallabhajosyula, Saraschandra
N1 - Publisher Copyright:
© 2022 Elsevier B.V.
PY - 2022/3
Y1 - 2022/3
N2 - 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.
AB - 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.
KW - Acute myocardial infarction
KW - Cardiac arrest
KW - Complications
KW - Female sex
KW - Healthcare disparities
KW - Outcomes research
UR - http://www.scopus.com/inward/record.url?scp=85124171663&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85124171663&partnerID=8YFLogxK
U2 - 10.1016/j.resuscitation.2022.01.024
DO - 10.1016/j.resuscitation.2022.01.024
M3 - Article
C2 - 35114326
AN - SCOPUS:85124171663
SN - 0300-9572
VL - 172
SP - 92
EP - 100
JO - Resuscitation
JF - Resuscitation
ER -