Sudden Cardiovascular Arrest During Sexual Intercourse
Authors: Ardalan Sharifzadehgan, Eloi Marijon, Wulfran Bougouin, Nicole Karam, Kumar Narayanan, Victor Waldmann, Lionel Lamhaut, Daniel Jost, Florence Dumas, Alain Cariou, Xavier Jouven
Journal: Circulation (2018)

sexual behavior ◼ survival C onsiderable apprehension often surrounds the issue of sudden cardiovascular arrest (SCA) during physical activity, especially that related to sexual intercourse.Sex-related SCA (SxSCA) has been mainly investigated through forensic studies, and epidemiological data are scarce. 1A comparison of the characteristics and outcomes of SxSCA with other SCAs may allow a better understanding of this dramatic condition.The Paris-SDEC registry (Paris-Sudden Death Expertise Center) has been described previously. 2 In brief, it is an ongoing, prospective, population-based study in Paris and its suburbs (population 6.7 million).Since May 2011, every case of outof-hospital SCA aged ≥18 years has been captured, and systematic information has been gathered.Appropriate institutional review boards approved the investigation with waiver of informed consent.Utstein templates and medical records were reviewed by 2 cardiologists.Data from all patients with SCA alive at hospital admission were analyzed.SxSCA was defined as any SCA occurring during coitus or within the following hour, and its characteristics were compared with SCA occurring during other physical activities (exercise-non SxSCA), and at rest (sedentary), as well.All patients admitted alive with a normal coronary angiogram and clinical evidence for a neurological issue systematically underwent a computed tomographic scan examination.Continuous data were expressed as mean.Categorical data were expressed as frequencies (percentages).We compared characteristics of SxSCA with exercise-non SxSCA and with sedentary SCA, overall.All analyses were 2-sided.Statistical analyses were performed by using R 3.4.2.From May 2011 to May 2016, 3028 patients with SCA were admitted alive.Overall, 17 (0.6%) patients had SxSCA, 229 (7.6%) had SCAs that occurred during physical activities other than sexual intercourse (138 during sports activities and 91 during moderate-to vigorous-intensity nonsport activities), and 2782 had SCAs that occurred at rest.In comparison with both exercise-non SxSCAs and SCAs at rest, patients with SxSCAs were more likely to be male (100% versus 88.2% versus 71.6%, respectively, P<0.001), younger (53.0 versus 56.2 versus 59.5 years, P<0.001), with a similar cardiovascular risk profile (≥1 factor, 81.2% versus 75.6% versus 81.5%, P=0.10), and a smaller prevalence of warning symptoms (37.5% versus 53.6% versus 71.4%, P<0.001).It is noteworthy that none of those with subarachnoid hemorrhages presented with neurological symptoms before SCA.Despite a high proportion of witnessed events (100% versus 95.6% versus 90.6%, P<0.001), patients with SxSCAs presented with higher delays from collapse to cardiopulmonary resuscitation (CPR; median, 5.0 versus 2.0 versus 4.0 minutes, P<0.001), lower bystander CPR (47.1% versus 80.3% versus 62.6%, P<0.001), less initial shockable rhythm (41.2% versus 72.5% versus 50.7%,P<0.001), and lower survival rate at hospital discharge (11.8% versus 50.2% versus 24.9%, P<0.001).