Improvements in time to reperfusion: do women have an advantage?

Several studies demonstrate that women have greater delays in primary percutaneous coronary intervention (PCI). To improve care for women, the Women's Heart Advantage at Yale-New Haven Hospital (YNHH) developed patient- and physician-level interventions to improve knowledge about chest pain syndromes to promote early presentation, diagnosis, and timely management of ST-elevation myocardial infarction (STEMI) in women presenting to the emergency department. Specifically, we analyzed chart-abstracted data from all patients undergoing PCI for STEMI at YNHH from January 2004 to July 2007 and assessed quality of care for STEMI and trends in time to reperfusion. Women's Heart Advantage and YNHH orchestrated several clinical initiatives and instituted hospital-wide systems to improve STEMI care over this period. Both men and women had declines in time to reperfusion (91-73 minutes for men and 120-74 minutes for women). Notably, improvements in time to reperfusion were more substantial in women; the greatest improvement was reduction in door-to-table time (50% decrease in women vs. 19% decrease in men [P < 0.05]). In this single-site study of men and women undergoing primary PCI at a large, urban teaching hospital, where ongoing interventions to increase both patient and physician awareness regarding heart disease in women were initiated, time to reperfusion for women improved to a greater degree than in men. These results are encouraging, showing that significant improvements can be made over a relatively short time frame. It is hoped these reductions in time to reperfusion are associated with improved outcomes; however, further studies are needed to verify this potential benefit.