Temporal trends in patient and treatment delay among men and women presenting with ST-elevation myocardial infarction

Kaul, Padma; Armstrong, Paul W.; Sookram, Sunil; Leung, Becky; Brass, Neil; Welsh, Robert C.

doi:10.1016/j.ahj.2010.09.016

Cited by 106 publications

(64 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…From prior studies, it is known that female patients wait longer to activate EMS during a STEMI 23, 24. Results from the analysis corroborate those data as female patients have longer symptom onset to contact times when compared to male patients.…”

Section: Discussionsupporting

confidence: 71%

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

Roswell

Kunkes

Chen

et al. 2017

JAHA

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 71%

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

Roswell

Kunkes

Chen

et al. 2017

JAHA

View full text Add to dashboard Cite

show abstract

“…4,6,22 However, we did not observe any differences between men and women with regard to the odds of receiving timely primary percutaneous intervention, in contrast to previous studies showing longer door-to-balloon times among older women than older men. 4,6,23 This difference may relate to differences in age between the study populations. To our knowledge, this is the first study assessing sex-related differences in and determinants of access to care within a cohort of patients with premature acute coronary syndrome.…”

mentioning

confidence: 99%

Sex-related differences in access to care among patients with premature acute coronary syndrome

Pelletier

Humphries²,

Shimony³

et al. 2014

CMAJ

114

110

View full text Add to dashboard Cite

Among younger adults with acute coronary syndrome, women and men had different access to care. Moreover, fewer than half of men and women with ST-segment elevation MI received timely primary coronary intervention. Our results also highlight that men and women with no chest pain and those with anxiety, several traditional risk factors and feminine personality traits were at particularly increased risk of poorer access to care.

show abstract

“…[1][2][3][4][5][6] Higher in-hospital mortality in women was often attributed to a longer patient delay before admission, older age, a higher clustering of cardiovascular risk factors, lower use of invasive and medical treatment, and more bleeding complications after interventions. [6][7][8][9][10][11][12][13] Remarkably, especially in the younger age groups, women had a worse outcome compared with age-matched men. [14][15][16][17][18] This may be related to a variety of factors such as gender differences in plaque composition, differences in thrombotic activity, and a higher prevalence of microvascular disease in younger women.…”

Section: Introductionmentioning

confidence: 99%

Is the difference in outcome between men and women treated by primary percutaneous coronary intervention age dependent? Gender difference in STEMI stratified on age

Otten

Maas²,

Ottervanger

et al. 2013

European Heart Journal: Acute Cardiovascular Care

119

View full text Add to dashboard Cite

on behalf of the Zwolle myocardial infarction study group Abstract Aim: Poorer outcomes in women with ST-elevation myocardial infarction (STEMI) are often attributed to gender differences in baseline characteristics. However, these may be age dependent. We examined the importance of gender in separate age groups of patients with STEMI undergoing primary percutaneous coronary intervention (PPCI). Methods and results: Data of 6746 consecutive patients with STEMI admitted for PPCI between 1998 and 2008 in our hospital were evaluated. Age was stratified into two groups, <65 years (young group) and ≥65 years (elderly). Endpoints were enzymic infarct size as well as 30-day and 1 year mortality. We studied a total of 4991 (74.0%) men and 1755 (26.0%) women; 40% of women were <65 years and 60% of men were <65 years of age. In the elderly group (≥65 years), women had more frequently diabetes and hypertension while they smoked less frequently than men. Younger women smoked more often than similarly aged men and had more hypertension. At angiography, single-vessel disease and TIMI 3 flow before PPCI was more present in younger women than men, whereas these differences were not found in the older age group. Patient delay before admission was shorter in men at all ages, while women had lower creatine kinase levels. Younger women had a higher mortality after 30 days (HR 2.1, 95% CI 1.3−3.4) and at 1 year (HR 1.7, 95% CI 1.2−2.6), whereas in the older age group women mortality rates were higher at 30 days (HR 1.5, 95% CI 1.1−2.0) but not at 1 year (HR 1.2, 95% CI 0.9−1.5). After multivariate analysis, 1-year mortality remained significantly higher in women at younger age (HR 1.7, 95% CI 1.1−2.5). Patient delay before admission was shorter in men in both age groups. Creatine kinase levels were in both age groups higher in men. Conclusions: Differences in mortality between men and women with STEMI treated with PPCI are age dependent. Although young women have less obstructive coronary artery disease and more often TIMI 3 flow before PCI (suggesting a lower risk), survival was worse compared to similarly aged men. Women had a longer patient delay compared to men, but this was not related to gender-specific mortality.

show abstract

Temporal trends in patient and treatment delay among men and women presenting with ST-elevation myocardial infarction

Cited by 106 publications

References 27 publications

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

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

Sex-related differences in access to care among patients with premature acute coronary syndrome

Is the difference in outcome between men and women treated by primary percutaneous coronary intervention age dependent? Gender difference in STEMI stratified on age

Contact Info

Product

Resources

About