Abstract 20241: Gender Disparities in Rates of Obstructive Coronary Artery Disease, Percutaneous Coronary Intervention, and Mortality in Adults With Cardiac Arrest

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Abstract

Introduction: Despite many advances in the field of resuscitation, cardiac arrest (CA) continues to have high rates of mortality. No studies have examined impact of gender on presence of obstructive coronary artery disease (CAD) in adults with CA.

Hypothesis: Gender is predictive of presence of obstructive CAD in adults with CA.

Methods: The study included 208 consecutive patients hospitalized with CA who underwent ACLS-guided resuscitation and coronary angiogram from February 2010 - December 2014 at an academic tertiary medical center. Baseline demographic and clinical data were recorded. The primary outcome was presence of obstructive CAD, defined as ≥ 1 coronary artery or bypass graft with ≥ 70% stenosis. Secondary outcome was in-hospital mortality.

Results: Of the 208 patients studied, 150 (72.1%) were men and 58 (27.9%) were women. No difference in age or body mass index were noted between both genders. Women had higher rates of never smoking (44.6% vs 30.9%, p=0.020) and lower admission hemoglobin (12.1g/dl vs 13.5g/dl, p<0.001). Location of CA (in-hospital vs out-of-hospital), initial rhythm, use of defibrillation, and rates of ST-elevation myocardial infarction were similar in both groups. Women had a trend toward lower rates of obstructive CAD overall (69.0% vs 80.0%, p=0.090) and lower rates of multivessel CAD compared to men. Women had a trend toward lower rates of obstructive disease of the left circumflex (27.6% vs 42.0%, p=0.055) and right coronary arteries (37.9% vs 52.7%, p=0.057), but similar rates of obstructive disease of the left anterior descending artery (55.2% vs 60.0%, p=0.526). No difference in rates of percutaneous coronary intervention (62.0% vs 53.4%, p=0.260), therapeutic hypothermia (40.3% vs 32.8%, p=0.318), or vasopressors (42.7% vs 32.8%, p=0.191) were noted between men and women. Women were less likely to require an Impella percutaneous left ventricular support (1.7% vs 10.0%, p=0.046). Rates of in-hospital mortality were similar in men and women (23.3% vs 20.7%, p=0.683). In multivariate analysis, gender was not predictive of obstructive CAD.

Conclusions: In this observational study of adult with cardiac arrest undergoing coronary angiogram, gender was not independently predictive of obstructive CAD or mortality.

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