Background
Timely revascularization with percutaneous coronary intervention (
PCI
) reduces death following myocardial infarction. We evaluated if a sex gap in symptom‐to‐door (
STD
), door‐to‐balloon (
DTB
), and door‐to‐
PCI
time persists in contemporary patients, and its impact on mortality.
Methods and Results
From 2013 to 2016 the Victorian Cardiac Outcomes Registry prospectively recruited 13 451 patients (22.5% female) from 30 centers with ST‐segment–elevation myocardial infarction (
STEMI
, 47.8%) or non–ST‐segment–elevation myocardial infarction (NSTEMI) (52.2%) who underwent
PCI
. Adjusted log‐transformed
STD
and
DTB
time in the
STEMI
cohort and
STD
and door‐to‐
PCI
time in the NSTEMI cohort were analyzed using linear regression. Logistic regression was used to determine independent predictors of 30‐day mortality. In
STEMI
patients, women had longer log‐
STD
time (adjusted geometric mean ratio 1.20, 95%
CI
1.12‐1.28,
P
<0.001), log‐
DTB
time (adjusted geometric mean ratio 1.12, 95%
CI
1.05‐1.20,
P
=0.001), and 30‐day mortality (9.3% versus 6.5%,
P
=0.005) than men. Womens’ adjusted geometric mean
STD
and
DTB
times were 28.8 and 7.7 minutes longer, respectively, than were mens’ times. Women with
NSTEMI
had no difference in adjusted
STD
, door‐to‐
PCI
time, or early (<24 hours) versus late revascularization, compared with men. Female sex independently predicted a higher 30‐day mortality (odds ratio 1.67, 95%
CI
1.11‐2.49,
P
=0.01) in
STEMI
but not in NSTEMI.
Conclusions
Women with
STEMI
have significant delays in presentation and revascularization with a higher 30‐day mortality compared with men. The delay in
STD
time was 4‐fold the delay in
DTB
time. Women with NSTEMI had no delay in presentation or revascularization, with mortality comparable to men. Public awareness campaigns are needed to address women's recognition and early action for
STEMI
.
Nurses need to be aware that manual restraint is not just an accepted part of their work, but is a strategy of last resort that should be documented. Organisations must implement standardised educational programmes for nurses together with policies and processes to monitor and evaluate manual restraint events.
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