Impact of Sex and Contact‐to‐Device Time on Clinical Outcomes in Acute ST‐Segment Elevation Myocardial Infarction—Findings From the National Cardiovascular Data Registry

Abstract

BackgroundEmergent myocardial reperfusion via primary percutaneous coronary intervention is optimal care for patients presenting with ST‐segment elevation myocardial infarction (STEMI). Delays in such interventions are associated with increases in mortality. With the shift in focus to contact‐to‐device (C2D) time as a new perfusion metric, this study was designed to examine how sex affects C2D time and mortality in STEMI patients.Methods and ResultsClinical data on male and female STEMI patients were extracted and analyzed from the National Cardiovascular Data Registry from July 1, 2008 to December 31, 2014. A total of 102 515 patients were included in the final analytic cohort. The median C2D time in female patients with STEMI was delayed when compared to male patients (80 [65–97] versus 75 [61–90] minutes; P<0.001). The unadjusted mortality was higher in female patients when compared to male patients with STEMI (4.1% versus 2.0%; P<0.001). For every 5‐minute increase in C2D time, the adjusted odds ratio for mortality was 1.04 (95% CI, 1.03–1.06) for female patients with STEMI and 1.07 (95% CI, 1.06–1.09) for male patients (P for sex by C2D interaction=0.003).ConclusionsTo date, this is the largest analysis of STEMI patients that measures the impact of the new recommended C2D reperfusion metric on in‐hospital mortality. Female STEMI patients have longer C2D times and increased mortality. The disparity can be improved and survival can increase in this high‐risk patient cohort by decreasing systems issues that cause increased reperfusion times in female STEMI patients.

Sex-based differences in quality of care and outcomes in a health system using a standardized STEMI protocol

“…Female sex was not a significant predictor of mortality in a multivariate model, suggesting that biological sex differences are not a major factor in the sex disparity in post-STEMI mortality when using a standardized PCI-based STEMI protocol. These results are important, as the recently published STEMI data from the National Cardiovascular Data Registry (NCDR) Acute Coronary Treatment and Intervention Outcomes Network Registry—Get With The Guidelines (ACTION-GWTG) demonstrated that 1) median contact-to-device time remains longer in women than men, 2) 32.5% of female STEMI patients did not meet the recommended target time ≤90 minutes compared with 24.4% of male patients, 3) longer reperfusion time was associated with increased mortality for both women and men, and importantly 4) adjusted mortality rate was higher in female STEMI patients than male STEMI patients 12 . We demonstrate that in a PCI-based STEMI system using a standardized STEMI protocol and reduced treatment disparities, female sex is no longer a predictor of mortality.…”

Sex Differences in Ischemic Heart Disease

“…[59][60][61] Additionally, women also experience a higher incidence of cardiogenic shock (5.8% versus 4.0%) and heart failure (5.8% versus 3.4%) compared with men ( Figure 1). 2,39,63 These differences in outcome were ameliorated after adjusting for baseline comorbidities. These disparate outcomes are potentially caused by a combination of less-intensive hospital and postdischarge care 44,48,64 and underlying biological differences in response to pharmacological and reperfusion therapies.…”

“…67 However, a decade later, significant disparities persist in timeliness of revascularization, with women experiencing longer median first medical contact-to-device times (80 versus 75 minutes; P<0.001) and a lower propensity to achieve the recommended contact-to-device times ≤90 minutes target than men (67.5% versus 75.6%; P<0.001). 39 This delay was secondary to differences in both prehospital presentation times and in getting crucial admission procedures, with longest delays in young women (aged 18-55 years). 39,41 These findings underscore the need for improved symptom recognition and triage strategies used by first responders, particularly in young women.…”

“…39 This delay was secondary to differences in both prehospital presentation times and in getting crucial admission procedures, with longest delays in young women (aged 18-55 years). 39,41 These findings underscore the need for improved symptom recognition and triage strategies used by first responders, particularly in young women.…”

Gender difference in the impact of Ischaemic heart disease on heart failure

“…Unlike men, the change in these protective and compensatory mechanisms of oestrogen owing to menopause affects the prognosis of HF cause by IHD, making a prognosis that is sensitive and vulnerable to IHD, especially all‐cause death in women. In addition to these biological factors, the atypical symptom presentation and delayed first medical contact time in women, inappropriately delayed treatment due to these and less intensive medical therapy may also affect the prognosis of HF cause by IHD 26,27 . Park el al 28 showed that women have a higher mortality than men after ST‐segment elevation myocardial infarction in Korean Acute Myocardial Infarction Registry (KAMIR) study, and this gender difference explained that women are limited to early aggressive intervention due to their advanced age and late detection.…”