Caputo Maria Luce, Baldi Enrico, Krüll Joel Daniel, Pongan Damiano, Cresta Ruggero, Benvenuti Claudio, Cianella Roberto, Primi Roberto, Currao Alessia, Bendotti Sara, Compagnoni Sara, Gentile Francesca Romana, Anselmi Luciano, Savastano Simone, Klersy Catherine, Auricchio Angelo
Cardiology Department, Cardiocentro Ticino Institute, Lugano, Switzerland.
Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Front Cardiovasc Med. 2023 Apr 11;10:1074432. doi: 10.3389/fcvm.2023.1074432. eCollection 2023.
There are limited data on sex-related differences in out-of hospital cardiac arrests (OHCAs) with refractory ventricular arrhythmias (VA) and, in particular, about their relationship with cardiovascular risk profile and severity of coronary artery disease (CAD).
Aim of this study was to characterize sex-related differences in clinical presentation, cardiovascular risk profile, CAD prevalence, and outcome in OHCA victims presenting with refractory VA.
All OHCAs with shockable rhythm that occurred between 2015 and 2019 in the province of Pavia (Italy) and in the Canton Ticino (Switzerland) were included.
Out of 680 OHCAs with first shockable rhythm, 216 (33%) had a refractory VA. OHCA patients with refractory VA were younger and more often male. Males with refractory VA had more often a history of CAD (37% vs. 21%, 0.03). In females, refractory VA were less frequent (M : F ratio 5 : 1) and no significant differences in cardiovascular risk factor prevalence or clinical presentation were observed. Male patients with refractory VA had a significantly lower survival at hospital admission and at 30 days as compared to males without refractory VA (45% vs. 64%, < 0.001 and 24% vs. 49%, < 0.001, respectively). Whereas in females, no significant survival difference was observed.
In OHCA patients presenting with refractory VA the prognosis was significantly poorer for male patients. The refractoriness of arrhythmic events in the male population was probably due to a more complex cardiovascular profile and in particular due to a pre-existing CAD. In females, OHCA with refractory VA were less frequent and no correlation with a specific cardiovascular risk profile was observed.
关于院外心脏骤停（OHCA）合并难治性室性心律失常（VA）的性别差异数据有限，尤其是关于它们与心血管风险状况及冠状动脉疾病（CAD）严重程度的关系。
本研究旨在描述OHCA合并难治性VA患者在临床表现、心血管风险状况、CAD患病率及预后方面的性别差异。
纳入2015年至2019年在意大利帕维亚省和瑞士提契诺州发生的所有可电击心律的OHCA病例。
在680例首次出现可电击心律的OHCA病例中，216例（33%）为难治性VA。OHCA合并难治性VA的患者更年轻，男性更为常见。合并难治性VA的男性患者CAD病史更为常见（37%对21%，P = 0.03）。在女性中，难治性VA较少见（男性与女性比例为5∶1），且在心血管危险因素患病率或临床表现方面未观察到显著差异。与无难治性VA的男性患者相比，合并难治性VA的男性患者入院时及30天时的生存率显著更低（分别为45%对64%，P<0.001；24%对49%，P<0.001）。而在女性中，未观察到显著的生存差异。
在OHCA合并难治性VA的患者中，男性患者的预后明显更差。男性人群心律失常事件的难治性可能归因于更复杂的心血管状况，尤其是由于存在CAD。在女性中，OHCA合并难治性VA较少见，且未观察到与特定心血管风险状况的相关性。
