Teodorescu Carmen, Reinier Kyndaron, Uy-Evanado Audrey, Ayala Jo, Mariani Ronald, Wittwer Lynn, Gunson Karen, Jui Jonathan, Chugh Sumeet S
The Heart Institute, Cedars-Sinai Medical Center, Saperstein Plaza Suite 2S46, 8700 Beverly Blvd, Los Angeles, CA 90048, USA.
J Interv Card Electrophysiol. 2012 Sep;34(3):219-25. doi: 10.1007/s10840-012-9669-2. Epub 2012 Mar 11.
Studies evaluating a possible survival advantage from sudden cardiac arrest (SCA) in women have produced mixed results possibly due to a lack of comprehensive analyses. We hypothesized that race, socioeconomic status (SES), and elements of the lifetime clinical history influence gender effects and need to be incorporated within analyses of survival.
Cases of SCA were identified from the ongoing, prospective, multiple-source Oregon Sudden Unexpected Death Study (population approximately one million). Subjects included were age ≥18 years who underwent attempted resuscitation by EMS providers. Pearson's chi-square tests and independent samples t tests or analysis of variance were used for univariate comparisons. We evaluated gender and race differences in survival adjusted for age, circumstances of arrest, disease burden, and socioeconomic status using a logistic regression model predicting survival.
A total of 1,296 cases had resuscitation attempted (2002-2007; mean age 65 years, male 67%). Women were older than men (68 vs. 63 years, p < 0.0001) and were more likely to have return of spontaneous circulation (41% vs. 33%, p = 0.004). Women were more likely to present with pulseless electrical activity (PEA) and asystole (p < 0.0001), and overall, PEA was more common among African Americans (p = 0.04). Higher survival to hospital discharge was observed in women compared to men presenting with ventricular fibrillation/tachycardia (34% vs. 24%, p = 0.02) or with PEA (10% vs. 3%, p = 0.007). In a multivariate model adjusting for age, race, presenting arrhythmia, arrest circumstances, arrest location, disease burden, and SES, women were more likely than men to survive to hospital discharge [odds ratio 1.85; 95% confidence interval (1.12-3.04)].
Despite older age, higher prevalence of SCA in the home, and higher rates of PEA, women had a survival advantage from ventricular fibrillation and pulseless electrical activity.
评估女性心脏骤停（SCA）可能存在的生存优势的研究结果不一，这可能是由于缺乏全面分析所致。我们推测种族、社会经济地位（SES）和终生临床病史因素会影响性别差异，需要纳入生存分析之中。
从正在进行的、前瞻性的、多源的俄勒冈州意外猝死研究（人口约100万）中识别SCA病例。纳入的受试者年龄≥18岁，由急救医疗服务人员进行复苏尝试。使用Pearson卡方检验、独立样本t检验或方差分析进行单变量比较。我们使用预测生存的逻辑回归模型评估了在调整年龄、骤停情况、疾病负担和社会经济地位后生存情况的性别和种族差异。
共有1296例进行了复苏尝试（2002 - 2007年；平均年龄65岁，男性占67%）。女性比男性年龄大（68岁对63岁，p < 0.0001），且更有可能恢复自主循环（41%对33%，p = 0.004）。女性更有可能表现为无脉电活动（PEA）和心搏停止（p < 0.0001），总体而言，PEA在非裔美国人中更常见（p = 0.04）。与出现心室颤动/心动过速（34%对24%，p = 0.02）或PEA（10%对3%，p = 0.007）的男性相比，女性出院时的生存率更高。在调整年龄、种族、出现的心律失常、骤停情况、骤停地点、疾病负担和SES的多变量模型中，女性比男性更有可能存活至出院[比值比1.85；95%置信区间（1.12 - 3.04）]。
尽管女性年龄较大、在家中发生SCA的患病率较高且PEA发生率较高，但在心室颤动和无脉电活动方面女性具有生存优势。
