Sex Differences Persist in Time to Presentation, Revascularization, and Mortality in Myocardial Infarction Treated With Percutaneous Coronary Intervention

Research output: Contribution to journalArticleResearchpeer-review

1 Citation (Scopus)

Abstract

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 .

Original languageEnglish
Article numbere012161
Number of pages9
JournalJournal of the American Heart Association
Volume8
Issue number10
DOIs
Publication statusPublished - 21 May 2019

Keywords

  • non–ST‐segment elevation acute coronary syndrome
  • revascularization
  • ST‐segment–elevation myocardial infarction

Cite this

@article{4ce6c5b790a84b51932c9f282a4283a1,
title = "Sex Differences Persist in Time to Presentation, Revascularization, and Mortality in Myocardial Infarction Treated With Percutaneous Coronary Intervention",
abstract = "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 .",
keywords = "non–ST‐segment elevation acute coronary syndrome, revascularization, ST‐segment–elevation myocardial infarction",
author = "Julia Stehli and Catherine Martin and Angela Brennan and Dinh, {Diem T.} and Jeffrey Lefkovits and Sarah Zaman",
year = "2019",
month = "5",
day = "21",
doi = "10.1161/JAHA.119.012161",
language = "English",
volume = "8",
journal = "American Heart Association. Journal. Cardiovascular and Cerebrovascular Disease",
issn = "2047-9980",
publisher = "American Heart Association",
number = "10",

}

TY - JOUR

T1 - Sex Differences Persist in Time to Presentation, Revascularization, and Mortality in Myocardial Infarction Treated With Percutaneous Coronary Intervention

AU - Stehli, Julia

AU - Martin, Catherine

AU - Brennan, Angela

AU - Dinh, Diem T.

AU - Lefkovits, Jeffrey

AU - Zaman, Sarah

PY - 2019/5/21

Y1 - 2019/5/21

N2 - 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 .

AB - 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 .

KW - non–ST‐segment elevation acute coronary syndrome

KW - revascularization

KW - ST‐segment–elevation myocardial infarction

UR - http://www.scopus.com/inward/record.url?scp=85066871713&partnerID=8YFLogxK

U2 - 10.1161/JAHA.119.012161

DO - 10.1161/JAHA.119.012161

M3 - Article

VL - 8

JO - American Heart Association. Journal. Cardiovascular and Cerebrovascular Disease

JF - American Heart Association. Journal. Cardiovascular and Cerebrovascular Disease

SN - 2047-9980

IS - 10

M1 - e012161

ER -