Sex differences in patients with out-of-hospital cardiac arrest without ST-segment elevation: A COACT trial substudy

E.M. Spoormans, J.S. Lemkes*, G.N. Janssens, N.W. van der Hoeven, L.S.D. Jewbali, E.A. Dubois, P.M. van de Ven, M. Meuwissen, T.A. Rijpstra, H.A. Bosker, M.J. Blans, G.B. Bleeker, R. Baak, G.J. Vlachojannis, B.J.W. Eikemans, P. van der Harst, I.C.C. van der Horst, M. Voskuil, J.J. van der Heijden, A. BeishuizenM. Stoel, C. Camaro, H. van der Hoeven, J.P. Henriques, A.P.J. Vlaar, M.A. Vink, B. van den Bogaard, T.A.C.M. Heestermans, W. de Ruijter, T.S.R. Delnoij, H.J.G.M. Crijns, G.A.J. Jessurun, P.V. Oemrawsingh, M.T.M. Gosselink, K. Plomp, M. Magro, P.W.G. Elbers, Y. Appelman, N. van Royen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Whether sex is associated with outcomes of out-of-hospital cardiac arrest (OHCA) is unclear.Objectives: This study examined sex differences in survival in patients with OHCA without ST-segment elevation myocardial infarction (STEMI).Methods: Using data from the randomized controlled Coronary Angiography after Cardiac Arrest (COACT) trial, the primary point of interest was sex differences in OHCA-related one-year survival. Secondary points of interest included the benefit of immediate coronary angiography compared to delayed angiography until after neurologic recovery, angiographic and clinical outcomes.Results: In total, 522 patients (79.1% men) were included. Overall one-year survival was 59.6% in women and 63.4% in men (HR 1.18; 95% CI: 0.761.81;p = 0.47). No cardiovascular risk factors were found that modified survival. Women less often had significant coronary artery disease (CAD) (37.0% vs. 71.3%; p < 0.001), but when present, they had a worse prognosis than women without CAD (HR 3.06; 95% CI 1.31-7.19; p = 0.01). This was not the case for men (HR 1.05; 95% CI 0.67-1.65; p = 0.83). In both sexes, immediate coronary angiography did not improve one-year survival compared to delayed angiography (women, odds ratio (OR) 0.87; 95% CI 0.58-1.30;p = 0.49; vs. men, OR 0.97; 95% CI 0.45-2.09; p = 0.93).Conclusion: In OHCA patients without STEMI, we found no sex differences in overall one-year survival. Women less often had significant CAD, but when CAD was present they had worse survival than women without CAD. This was not the case for men. Both sexes did not benefit from a strategy of immediate coronary angiography as compared to delayed strategy with respect to one-year survival.
Original languageEnglish
Pages (from-to)14-22
Number of pages9
Publication statusPublished - 1 Jan 2021


  • coronary angiography
  • differences
  • gender
  • out-of-hospital cardiac arrest
  • outcomes
  • sex


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