Sudden Cardiac Arrest In Young Women

HomeCirculationVol. 143, No. 7Sudden Cardiac Arrest in Young Women Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessLetterPDF/EPUBSudden Cardiac Arrest in Young Women Orianne Weizman, MD, MPH, Ardalan Sharifzadehgan, MD, MPH, Wulfran Bougouin, MD, PhD, Kumar Narayanan, MD, Noémie Tence, MD, Florence Dumas, MD, PhD, Victor Waldmann, MD, PhD, Lionel Lamhaut, MD, PhD, Daniel Jost, MD, Karim Wahbi, MD, PhD, Olivier Varenne, MD, PhD, Rodrigue Garcia, MD, PhD, Nicole Karam, MD, PhD, Alain Cariou, MD, PhD, Xavier Jouven, MD, PhD and Eloi Marijon, MD, PhD Orianne WeizmanOrianne Weizman https://orcid.org/0000-0002-1527-0332 University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.). Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.). Nancy University Hospital, Cardiology Department, France (O.W.). Search for more papers by this author , Ardalan SharifzadehganArdalan Sharifzadehgan https://orcid.org/0000-0002-3465-6724 University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.). Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.). European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.). Search for more papers by this author , Wulfran BougouinWulfran Bougouin Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.). Jacques Cartier Hospital, Intensive Care Unit, Massy, France (W.B.). Search for more papers by this author , Kumar NarayananKumar Narayanan Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.). Medicover Hospitals, Cardiology Department, Hyderabad, India (K.N.). Search for more papers by this author , Noémie TenceNoémie Tence University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.). Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.). European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.). Search for more papers by this author , Florence DumasFlorence Dumas University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.). Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.). Cochin Hospital, Emergency Department, Paris, France (F.D.). Search for more papers by this author , Victor WaldmannVictor Waldmann https://orcid.org/0000-0001-8057-1900 University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.). Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.). European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.). Search for more papers by this author , Lionel LamhautLionel Lamhaut https://orcid.org/0000-0003-4160-9456 University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.). Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.). Emergency Medical Services 75, Necker University Hospital, APHP, Paris, France (L.L.). Search for more papers by this author , Daniel JostDaniel Jost https://orcid.org/0000-0002-6046-1234 Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.). Paris Firefighters Brigade, France (D.J.). Search for more papers by this author , Karim WahbiKarim Wahbi https://orcid.org/0000-0001-7682-7387 University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.). Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.). Cochin Hospital, Cardiology Intensive Care Unit (K.W., O.V.), Paris, France. Search for more papers by this author , Olivier VarenneOlivier Varenne https://orcid.org/0000-0002-1308-8860 University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.). Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.). Cochin Hospital, Cardiology Intensive Care Unit (K.W., O.V.), Paris, France. Search for more papers by this author , Rodrigue GarciaRodrigue Garcia https://orcid.org/0000-0001-9350-2437 Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.). Cardiovascular Center, University Hospital La Milétrie, Poitiers, France (R.G.). University of Poitiers, France (R.G.). Search for more papers by this author , Nicole KaramNicole Karam University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.). Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.). European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.). Search for more papers by this author , Alain CariouAlain Cariou University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.). Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.). Intensive Care Unit (A.C.), Paris, France. Search for more papers by this author , Xavier JouvenXavier Jouven University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.). Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.). European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.). *Drs Jouven and Marijon contributed equally. Search for more papers by this author and Eloi MarijonEloi Marijon Eloi Marijon, MD, PhD, Hôpital Européen Georges Pompidou, Département de Cardiologie, 20-40 Rue Leblanc 75908 Paris Cedex 15, France. Email E-mail Address: [email protected] https://orcid.org/0000-0001-7227-3428 University of Paris, Paris-Cardiovascular Research Center, Institut National de la Santé et de la Recherche Médicale, France (O.W., A.S., N.T., N.K., F.D., V.W., L.L., K.W., O.V., A.C., X.J., E.M.). Paris-Sudden Death Expertise Center, France (O.W., A.S., W.B., K.N., N.T., N.K., F.D., V.W., L.L., D.J., K.W., O.V., R.G., A.C., X.J., E.M.). European Georges Pompidou Hospital, Cardiology Department, Paris, France (A.S., N.T., N.K., V.W., X.J., E.M.). *Drs Jouven and Marijon contributed equally. Search for more papers by this author and For the Paris-SDEC Investigators† Originally published15 Feb 2021https://doi.org/10.1161/CIRCULATIONAHA.120.052219Circulation. 2021;143:758–760The burden of sudden cardiac arrest (SCA) among women has been shown to be substantial, accounting for about one-third of cases.1–3 There is especially limited knowledge on younger, premenopausal women.The prospective, population based Paris SDEC registry includes individuals living in Paris and its suburbs as previously described.4 The study is conducted in compliance with Good Clinical Practice, French law, and the French data protection law. The data file of the Paris-SDEC registry was declared to and authorized by the French data protection committee (Commission Nationale Informatique et Liberté). The data, analytic methods, and study materials will not be made available to other researchers for purposes of reproducing the results or replicating the procedure. All adult (≥18 years of age) patients with SCA occurring from May 15, 2011, to May 15, 2018, were prospectively included. SCA was defined as an unexpected out-of-hospital cardiac arrest with a rapid witnessed collapse within 1 hour of symptom onset, or if unwitnessed, within the 24 hours after last contact. SCA with obvious noncardiac circumstances or known terminal illnesses were not included. Therapeutic interventions and etiologic testing were left to the discretion of local teams. This analysis was restricted to young women <40 years of age. Acute coronary syndrome was defined as the presence of a culprit lesion at coronary angiogram deemed responsible for the SCA event, whereas chronic coronary syndrome was diagnosed in the absence of acute culprit lesion. Myocardial infarction with nonobstructive coronary arteries was defined as myocardial infarction with no major epicardial coronary artery stenosis ≥50% on angiography and no alternative diagnosis for the clinical presentation.From May 15, 2011, to May 15, 2018, 14 210 SCA were recorded, including 1062 young (<40 years of age) victims, of which 336 (31.6%) 18 to 40 years old were women. Sixty-seven women (19.9%) had sudden cardiac death without resuscitation attempt. Mean age at the time of the event was 31.3±5.8 years. SCA was the first expression of any underlying disease in 89 (63.1%) cases. Smoking (current or past) was present in 39 cases (29.8%), systemic hypertension in 10 (7.5%), dyslipidemia in 5 (3.8%), diabetes in 3 (2.3%), and overweight (body mass index >25) in 31 (23.5%). In addition, 22 (16.5%) patients had a previous history of cardiovascular disease, mainly nonischemic heart disease (14 patients), and 9 had a family member who had a history of SCA under the age of 50 years old. SCA occurred during pregnancy in 14 cases (4.2%).On circumstances and resuscitation, SCA occurred mainly at home (N=200, 74.3%). Most women were not involved in any vigorous physical or sports activity at the time of SCA, with only 5 cases (2.0%) occurring during sports. SCA was witnessed in 194 cases (73.2%), cardiopulmonary resuscitation was initiated in 142 cases (69.6%), and a public automatic external defibrillator was used in 3 cases (1.9%). Initial shockable rhythm was found in 73 cases (29.4%). Of the 269 cases (80.1%) with resuscitation attempted on site, 141 (42.0%) were admitted alive to the hospital. Forty-five (16.7%) were discharged alive.The final diagnosis causing SCA remained undertermined in 231 patients (68.8%). Among the 105 patients with an established diagnosis, noncardiac etiologies represented half of the cases (53 patients, 50.5%), mainly neurological causes (N=18, 34.0%). Cardiac etiologies were observed in 52 cases (49.5%), including nonischemic cardiomyopathy in 19 (36.5%), acute coronary syndrome in 18 (34.6%), nonstructural heart disease in 13 (25.0%), and chronic coronary syndrome in 2 (3.8%). Myocardial infarction with nonobstructive coronary arteries was uncommon, with 1 case of spontaneous coronary artery dissection and 3 cases of coronary artery vasospasm. Etiologies stratified by age group (<30 versus ≥30 years old) are represented in the Figure.Download figureDownload PowerPointFigure. Causes of sudden cardiac arrest in young women according to age (<30 years or 30–40 years).Among the 269 young women with resuscitation attempted, only 7 families (5.0%) underwent screening. Among women who died in the hospital (after a mean duration of 2.2±3.9 days), only 13 (13.5%) underwent the triad of investigations coronary angiography, computed tomography scan, and transthoracic echocardiography. Among the 45 young women discharged alive, only 7 family genetic analyses (15.6%) and 3 family screenings (6.7%) were initiated, with 22 (48.9%) having an implantable and 2 (4.4%) a wearable cardioverter-defibrillator.In our study, the majority of SCA among young women remained of undetermined origin (up to 75%), mainly because of a lack of comprehensive cardiac investigations and a systematic approach (among both survivors and nonsurvivors). The low rates of autopsy and lack of systematic blood collection for genetic analysis and family screening led to missed opportunities to make a definitive diagnosis and guide future prevention measures. In young adults, this issue is even more crucial, given the greater likelihood of nonstructural and genetic causes.5 Systematic workup will have dual benefits of enabling targeted therapies for survivors and prevention among first-degree relatives. Furthermore, early detection of cardiomyopathies in young women helps proper planning and preparation for pregnancy.In this population-based study, SCA in young women constituted a small but nonnegligible minority of all SCA and was most often the first expression of a pathological state. With an undiagnosed etiology in the majority of cases and a potentially greater contribution of noncardiac causes, urgent multidisciplinary efforts are needed to both improve management after SCA and prevention of the poorly explored condition of SCA in young women.AcknowledgmentsThe authors thank the Paris-SDEC for providing the logistical support and the Paris-SDEC collaborators for their multidisciplinary expertise that has allowed an optimal approach in the fight against sudden cardiac death through this collaborative network since 2011.Sources of FundingO. Weizman received a grant from the French Federation of Cardiology. The Paris-SDEC activities are supported by the Institut National de la Santé et de la Recherche Médicale, University of Paris, Assistance Publique-Hôpitaux de Paris, Fondation Cœur et Artères, Global Heart Watch, Fédération Française de Cardiologie, Société Française de Cardiologie, and Fondation Recherche Medicale, as well as unrestricted grants from industrial partners (Abbott, Biotronik, Boston Scientific, Medtronic, MicroPort, and Zoll). The Paris-SDEC Executive Committee is part of the ESCAPE-NET project (European Sudden Cardiac Arrest network towards Prevention, Education, New Effective Treatment; Horizon 2020 program).Supplemental MaterialsInvestigators in the Paris-Sudden Death Expertise CenterDisclosures None.Footnotes*Drs Jouven and Marijon contributed equally.†A complete list of the investigators in the Paris-Sudden Death Expertise Center is provided in the Data Supplement.https://www.ahajournals.org/journal/circThe Data Supplement is available with this article at https://www.ahajournals.org/doi/suppl/10.1161/CIRCULATIONAHA.120.052219.Eloi Marijon, MD, PhD, Hôpital Européen Georges Pompidou, Département de Cardiologie, 20-40 Rue Leblanc 75908 Paris Cedex 15, France. Email [email protected]frReferences1. Kim C, Fahrenbruch CE, Cobb LA, Eisenberg MS. Out-of-hospital cardiac arrest in men and women.Circulation. 2001; 104:2699–2703. doi: 10.1161/hc4701.099784LinkGoogle Scholar2. Albert CM, Chae CU, Grodstein F, Rose LM, Rexrode KM, Ruskin JN, Stampfer MJ, Manson JE. Prospective study of sudden cardiac death among women in the United States.Circulation. 2003; 107:2096–2101. doi: 10.1161/01.CIR.0000065223.21530.11LinkGoogle Scholar3. Haukilahti MAE, Holmström L, Vähätalo J, Kenttä T, Tikkanen J, Pakanen L, Kortelainen ML, Perkiömäki J, Huikuri H, Myerburg RJ, et al.. Sudden cardiac death in women.Circulation. 2019; 139:1012–1021. doi: 10.1161/CIRCULATIONAHA.118.037702LinkGoogle Scholar4. Waldmann V, Bougouin W, Karam N, Dumas F, Sharifzadehgan A, Gandjbakhch E, Algalarrondo V, Narayanan K, Zhao A, Amet D, et al.; Paris-SDEC investigators. Characteristics and clinical assessment of unexplained sudden cardiac arrest in the real-world setting: focus on idiopathic ventricular fibrillation.Eur Heart J. 2018; 39:1981–1987. doi: 10.1093/eurheartj/ehy098CrossrefMedlineGoogle Scholar5. Karam N, Pechmajou L, Dumas F, Bougouin W, Sharifzadehgan A, Beganton F, Bonnet G, Jost D, Lamhaut L, Varenne O, et al.; Paris Sudden Death Expertise Center (SDEC) Investigators. Comprehensive assessment of coronary artery disease in sports-related sudden cardiac arrest.Circulation. 2018; 138:429–431. doi: 10.1161/CIRCULATIONAHA.118.034664LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails February 16, 2021Vol 143, Issue 7 Advertisement Article InformationMetrics © 2021 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.120.052219PMID: 33587656 Originally publishedFebruary 15, 2021 Keywordssudden cardiac deathyoungsexwomensudden cardiac arrestPDF download Advertisement SubjectsEpidemiologySudden Cardiac DeathWomen, Sex, and Gender