Morning peak and high prevalence of pulmonary embolism and psychiatric disorders in women with sudden cardiac arrest: results from the ReCaPTa study.

BACKGROUND: Sudden cardiac arrest (SCA) in women remains understudied, often leading to generalised approaches. We aimed to identify sex-specific differences in the clinical profile, risk factors, and causes of SCA to guide targeted interventions. METHODS: This prospective population-based study (ReCaPTa) analysed out-of-hospital cardiac arrests in a region of Spain (2014-2017). Data were triangulated from Emergency Medical Services, hospital records, and forensic autopsies. SCA was defined as an unexpected cardiac arrest, with a presumed cardiac cause, occurring within 1 h of symptom onset or seen to be alive and well within the last 24 h. RESULTS: Of 639 SCA cases, 191 (29.9%) were women. Compared with men, women were older (74 vs 66 years, p < 0.001), had more morning SCA and had a higher prevalence of previous psychiatric disorders (15.6% vs 9.0%, p = 0.03) and alcohol abuse (25.4% vs 16.1%, p = 0.01). Toxicological analysis showed significantly higher antidepressant positivity in women (11.3% vs 1.8%, p = 0.004). Women had fewer shockable rhythms (21% vs 36%, p = 0.01), fewer resuscitation attempts, and lower survival rates (4.2% vs 9.9%, p = 0.01). While acute coronary disease was the leading cause in women (20.0%), they exhibited a distinct non-ischaemic profile: pulmonary embolism (PE) was more frequent than in men (13.3% vs 3.0%, p < 0.001) and was universally fatal (0% survival). CONCLUSION: Compared with men, women with SCA exhibited a disproportionately higher burden of PE and a greater involvement of psychotropic drugs and toxic substances.