TY - JOUR
T1 - Sex differences in prehospital delays in patients with st-segment-elevation myocardial infarction undergoing percutaneous coronary intervention
AU - Stehli, Julia
AU - Dinh, Diem
AU - Dagan, Misha
AU - Duffy, Stephen J.
AU - Brennan, Angela
AU - Smith, Karen
AU - Andrew, Emily
AU - Nehme, Ziad
AU - Reid, Christopher M.
AU - Lefkovits, Jeffrey
AU - Stub, Dion
AU - Zaman, Sarah
N1 - Funding Information:
Dr Stehli is supported by a Monash University Scholarship. Associate Professor Stub receives a National Heart Foundation Fellowship. Associate Professor Duffy is supported by a National Health and Medical Research Council of Australia grant (No. 1111170). Associate Professor Zaman is supported by a National Heart Foundation Fellowship. She has also obtained research funding from Abbott Vascular and Biotronik Australia and speaking honoraria or consulting fees from AstraZeneca, Amgen, and Medtronic Australia. Dr Nehme is supported by a National Health and Medical Research Council Early Career Fellowship (No. 1146809). The remaining authors have no disclosures to report.
Publisher Copyright:
© 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021
Y1 - 2021
N2 - BACKGROUND: Women with ST-segment-elevation myocardial infarction experience delays in reperfusion compared with men with little data on each time component from symptom onset to reperfusion. This study analyzed sex discrepancies in patient delays, prehospital system delays, and hospital delays. METHODS AND RESULTS: Consecutive patients with ST-segment-elevation myocardial infarction treated with percutaneous coronary intervention across 30 hospitals in the Victorian Cardiac Outcomes Registry (2013-2018) were analyzed. Data from the Ambulance Victoria Data warehouse were used to perform linkage to the Victorian Cardiac Outcomes Registry for all patients transported via emergency medical services (EMS). The primary end point was EMS call-to-door time (prehospital system delay). Secondary end points included symptom-to-EMS call time (patient delay), door-to-device time (hospital delay), 30-day mortality, major adverse cardiovascular events, and major bleeding. End points were analyzed according to sex and adjusted for age, comorbidities, cardiogenic shock, cardiac arrest, and symptom onset time. A total of 6330 (21% women) patients with ST-segment-elevation myocardial infarction were transported by EMS. Compared with men, women had longer adjusted geometric mean symptom-to-EMS call times (47.0 versus 44.0 minutes; P<0.001), EMS call-to-door times (58.1 versus 55.7 minutes; P<0.001), and door-to-device times (58.5 versus 54.9 minutes; P=0.006). Compared with men, women had higher 30-day mortality (odds ratio [OR], 1.38; 95% CI, 1.06-1.79; P=0.02) and major bleeding (OR, 1.54; 95% CI, 1.08-2.20; P=0.02). CONCLUSIONS: Female patients with ST-segment-elevation myocardial infarction experienced excess delays in patient delays, prehospital system delays, and hospital delays, even after adjustment for confounders. Prehospital system and hospital delays resulted in an adjusted excess delay of 10 minutes compared with men.
AB - BACKGROUND: Women with ST-segment-elevation myocardial infarction experience delays in reperfusion compared with men with little data on each time component from symptom onset to reperfusion. This study analyzed sex discrepancies in patient delays, prehospital system delays, and hospital delays. METHODS AND RESULTS: Consecutive patients with ST-segment-elevation myocardial infarction treated with percutaneous coronary intervention across 30 hospitals in the Victorian Cardiac Outcomes Registry (2013-2018) were analyzed. Data from the Ambulance Victoria Data warehouse were used to perform linkage to the Victorian Cardiac Outcomes Registry for all patients transported via emergency medical services (EMS). The primary end point was EMS call-to-door time (prehospital system delay). Secondary end points included symptom-to-EMS call time (patient delay), door-to-device time (hospital delay), 30-day mortality, major adverse cardiovascular events, and major bleeding. End points were analyzed according to sex and adjusted for age, comorbidities, cardiogenic shock, cardiac arrest, and symptom onset time. A total of 6330 (21% women) patients with ST-segment-elevation myocardial infarction were transported by EMS. Compared with men, women had longer adjusted geometric mean symptom-to-EMS call times (47.0 versus 44.0 minutes; P<0.001), EMS call-to-door times (58.1 versus 55.7 minutes; P<0.001), and door-to-device times (58.5 versus 54.9 minutes; P=0.006). Compared with men, women had higher 30-day mortality (odds ratio [OR], 1.38; 95% CI, 1.06-1.79; P=0.02) and major bleeding (OR, 1.54; 95% CI, 1.08-2.20; P=0.02). CONCLUSIONS: Female patients with ST-segment-elevation myocardial infarction experienced excess delays in patient delays, prehospital system delays, and hospital delays, even after adjustment for confounders. Prehospital system and hospital delays resulted in an adjusted excess delay of 10 minutes compared with men.
KW - First medical contact
KW - Ischemic time
KW - Prehospital delay
KW - Sex discrepancies
KW - ST-segment-elevation myocardial infarction
UR - https://www.scopus.com/pages/publications/85110324346
U2 - 10.1161/JAHA.120.019938
DO - 10.1161/JAHA.120.019938
M3 - Article
C2 - 34155902
AN - SCOPUS:85110324346
SN - 2047-9980
VL - 10
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 13
M1 - e019938
ER -