Sex differences in outcomes for out-of-hospital cardiac arrest in the United States.
Sex differences in outcomes for out-of-hospital cardiac arrest in the United States.
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DOI：
10.1016/j.resuscitation.2021.03.020
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发表时间：
2021-06
期刊：
影响因子：
6.5
通讯作者：
Chan PS
中科院分区：
文献类型：
--
作者：
Kotini-Shah P;Del Rios M;Khosla S;Pugach O;Vellano K;McNally B;Vanden Hoek T;Chan PS
美国每天大约发生 1,000 例院外心脏骤停 (OHCA)。尽管中风和急性心肌梗死等其他心血管疾病也存在性别差异，但 OHCA 的性别差异却鲜为人知。具体而言，在美国，男性和女性之间 OHCA 后神经系统和生存结局的差异程度仍不清楚。在国家心脏骤停登记处以提高生存率 (CARES) 登记处，我们确定了 2013 年至 2019 年期间有 326,138 名患有 OHCA 的成年人。使用多变量逻辑回归，我们评估了入院生存率、出院生存率和良好的神经系统结果（即没有严重的神经功能障碍）方面的性别差异，并根据人口统计、心脏骤停特征和旁观者干预进行了调整。总体而言，117,281 名 (36%) 患者为女性。男性和女性的中位年龄分别为 62 岁和 65 岁。男性中初始可电击节律（25.1% vs 14.7%，标准化差异为 0.26）和在公共场所逮捕（22.2% vs. 11.3%；标准化差异为 0.30）在男性中更为常见，但目击逮捕率、旁观者心肺复苏率、静脉通路或使用机械装置进行心肺复苏率没有显着的性别差异。总体而言，男性和女性所有生存结果的未调整率相似：入院生存率（男性为 27.0%，女性为 27.9%，标准化差为 -0.02），出院生存率（男性为 10.5%，女性为 8.6%，标准化差为 0.07），以及良好的神经系统生存率（男性为 9.0%，女性为 6.6%，标准化差为 0.09）。然而，经过多变量调整后，男性存活至入院（调整后 OR= 0.75，95% CI：0.73，0.77）、存活至出院（调整后 OR= 0.83，95% CI：0.80，0.85）或具有良好神经系统存活（调整后 OR= 0.88，95% CI：0.85，0.91）的可能性较小。与女性相比，患有 OHCA 的男性具有更有利的心脏骤停特征，但存活入院、存活出院或具有良好神经系统存活的可能性较小。
Approximately 1,000 out-of-hospital cardiac arrest (OHCA) occur each day in the United States. Although sex differences exist for other cardiovascular conditions such as stroke and acute myocardial infarction, they are less well understood for OHCA. Specifically, the extent to which neurological and survival outcomes after OHCA differ between men and women remains poorly characterized in the U.S. Within the national Cardiac Arrest Registry to Enhance Survival (CARES) registry, we identified 326,138 adults with an OHCA from 2013–2019. Using multivariable logistic regression, we evaluated for sex differences in rates of survival to hospital admission, survival to hospital discharge, and favorable neurological outcome (i.e., without severe neurological disability), adjusted for demographics, cardiac arrest characteristics and bystander interventions. Overall, 117,281 (36%) patients were women. Median age was 62 and 65 years for men and women, respectively. An initial shockable rhythm (25.1% vs 14.7%, standardized difference of 0.26) and an arrest in a public location (22.2% vs. 11.3%; standardized difference of 0.30) were more common in men, but there were no meaningful sex differences in rates of witnessed arrests, bystander cardiopulmonary resuscitation, intra-venous access, or use of mechanical devices for delivering cardiopulmonary resuscitation. Overall, the unadjusted rates of all survival outcomes were similar between men and women: survival to hospital admission (27.0% for men vs. 27.9% for women, standardized difference of −0.02), survival to hospital discharge (10.5% for men vs. 8.6% for women, standardized difference of 0.07), and favorable neurological survival (9.0% for men vs. 6.6% for women, standardized difference of 0.09). After multivariable adjustment, however, men were less likely to survive to hospital admission (adjusted OR= 0.75, 95% CI: 0.73, 0.77), survive to hospital discharge (adjusted OR= 0.83, 95% CI: 0.80, 0.85), or have favorable neurological survival (adjusted OR= 0.88, 95% CI: 0.85, 0.91). Compared to women, men with OHCA have more favorable cardiac arrest characteristics but were less likely to survive to hospital admission, survive to discharge, or have favorable neurological survival.
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院外心脏骤停后的性别结合至结果 - 国际心脏骤停登记处的报告。
DOI：
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