Abstract
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. 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. Among 1219 OHCA admissions, 634 (52%) patients had angiographically confirmed CAD, and 580 (91.5%) were included in the final analysis (median age 61 years, 15.3% women). ST-segment elevation myocardial infarction was the predominant aetiology in both groups (64% in women vs. 59.9% in men). Men more frequently had a history of CAD and prior myocardial infarction. No significant sex-related differences were observed in PCI utilization, procedural success, targeted temperature management, or extracorporeal cardiopulmonary resuscitation use. Thirty-day survival was 66.2% in women and 61.5% in men (log-rank p = 0.33), while favourable neurological outcome (Cerebral Performance Category 1-2) occurred in 55.1% and 53.8%, respectively (p = 0.82). Men more frequently exhibited multivessel CAD, whereas women more often had identifiable culprit lesions. In multivariable analysis, sex was not significantly associated with 30-day survival (adjusted OR 0.75, 95% CI 0.39-1.41, p = 0.37). 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.