Gender disparities in percutaneous coronary intervention in out-of-hospital cardiac arrest

Background: Quality of post-arrest care is considered a significant factor for overall survival and neurological outcomes in out-of-hospital cardiac arrest (OHCA). However, previous studies suggested gender differences in invasive treatments including percutaneous coronary intervention (PCI). In this study, we evaluated gender disparities in the delivery of PCI among OHCA patients. Methods: All adults OHCA patients with presumed cardiac etiology and sustained ROSC between 2013 and 2016 were included in the study. Main exposure was gender and primary outcome was PCI treatment. Multivariable logistic regression was used to analyze the association between gender and PCI treatment, adjusting for patient, community, prehospital, and hospital factors. The time interval from return of spontaneous circulation (ROSC) to PCI and survival outcomes were also analyzed as secondary and tertiary outcomes. Results: A total of 20,675 patients were included for final analysis. Multivariable analysis showed that female patients were significantly less likely to receive PCI compared to males with adjusted odds ratio (OR) of 0.40 (95% CI 0.30-0.53). However, among those who received PCI, there were no significant associations between gender and time from ROSC to PCI (<= 90 vs. >90 min). Overall survival outcomes were not significantly associated with gender after adjusting for PCI and other confounding factors (OR = 0.87, 95% CI 0.71-1.08 for survival to discharge and OR = 0.87, 95% CI 0.70-1.08 for good neurological recovery). Conclusions: Among sustained ROSC patients following OHCA, female patients were significantly less likely to undergo PCI than males. Further studies are warranted to reduce gender disparities in caring for post-arrest patients. (C) 2018 Elsevier Inc. All rights reserved.