Sex-related Differences In Acute Coronary Care Among Patients With Myocardial Infarction: The Role Of Pre-hospital Delay

Bugiardini, Raffaele and Ricci, Beatrice and Cenko, Edina and Amaduzzi, Peter and Vasiljevic, Zorana and Dorobantu, Maria and Kedev, Sasko and Kalpak, Oliver and Vavlukis, Marija and Gustiene, Olivija and Manfrini, Olivia and Badimon, Lina and Trninic, Diana and Knezevic, Bozidarka and Milicic, Davor and Dilic, Mirza and Koller, Akos (2015) Sex-related Differences In Acute Coronary Care Among Patients With Myocardial Infarction: The Role Of Pre-hospital Delay. In: TCT/ACC 15, 14-17 March 2015, San Diego, USA.

[img]
Preview
Text
00080.pdf - Published Version

Download (288Kb) | Preview
Official URL: http://content.onlinejacc.org/article.aspx?article...

Abstract

Background: We sought to investigate sex-related differences in access to care among patients with myocardial infarction (STEMI) in order to identify gender-related factors associated with outcomes. Methods: We studied 7457 patients enrolled in the ISACS-TC registry 2010-2014 (ClinicalTrials.gov NCT01218776). Outcome measures were: inhospital mortality, time delay to call emergency medical services (EMS), home-to-hospital delay using EMS, door-to-needle and door-to-balloon times and the overall time to treatment from symptom onset. Constant variables included in logistic regression analyses were: age, risk factors, severity of clinical presentation, reperfusion therapies, and concurrent acute medications. Time to treatment from symptom onset was used as dummy variable. Results: Women were less likely than men to receive care within the benchmark time for reperfusion therapy (time to treatment from symptom onset <12 hours: 76.0% vs 80.4%, p <0.001). Accordingly, women were less likely than men to undergo reperfusion therapy by either p-PCI or fibrinolysis (69.5% vs 73.5 %, p = 0.003). Time delay to call EMS was longer in women (median: 60 min vs 55 min). As well, home-to-hospital delays ranged from 5 min to 3 days, with a home-to-hospital delays >60 min in 70.3% of women vs 29.7% of men. There were no significant differences in door-to-needle (median; 28 min vs 26 min) and door-to-balloon (median: 45 min vs 45 min) times. Major (z >4)determinants of poorer rates of reperfusion therapies included time to treatment from symptom onset >12 hours (adjusted OR: 5.37, CI: 4.58 - 6.31) Killip class > 2 (OR: 1.53, CI: 1.27-1.86) and history of prior heart failure (OR: 2.77, CI, 1.99 to 3.87). After adjustment, women had greater inhospital mortality rates than men (OR: 1.34, CI: 1.01-1.77). Sex differences in in-hospital mortality rates were no longer observed in the cohort, when time to treatment from symptom onset <12 hours was included in the multivariable analysis (OR: 1.31, CI: 0.98 -1.74). Conclusion: Sex differences in outcomes persist among STEMI patients, as fewer women receive timely reperfusion therapy. Pre-hospital delays in women experiencing STEMI remain unacceptably long.

Item Type: Conference or Workshop Item (Poster)
Subjects: Medical and Health Sciences > Clinical medicine
Divisions: Faculty of Medical Science
Depositing User: Marija Vavlukis
Date Deposited: 23 Jun 2015 08:40
Last Modified: 23 Jun 2015 08:40
URI: http://eprints.ugd.edu.mk/id/eprint/13332

Actions (login required)

View Item View Item