Evaluation of gender differences in Door-to-Balloon time in ST-elevation myocardial infarction
Rachel P Dreyer1, John F Beltrame, Rosanna Tavella
1Cardiology Unit, The Queen Elizabeth Hospital (The Basil Hetzel Institute), Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
Insights
Women with ST-elevation myocardial infarction (STEMI) face longer Door-to-Balloon (DTB) times due to delays in diagnosis and treatment. Addressing these gender-based disparities is crucial for improving STEMI care in women.
Area of Science:
- Cardiology
- Medical Research
- Gender Health Disparities
Background:
- Delayed Door-to-Balloon (DTB) time in ST-elevation myocardial infarction (STEMI) is linked to higher mortality rates.
- Previous studies suggest women may experience longer DTB times, but components and independent effects are not fully quantified.
Purpose of the Study:
- To quantify the specific components contributing to delayed DTB times in women with STEMI.
- To assess the independent impact of gender on DTB times for STEMI patients undergoing percutaneous coronary intervention (PCI).
Main Methods:
- Prospective collection of clinical data from 735 STEMI patients undergoing primary PCI between 2006 and 2010.
- Detailed analysis of DTB time components, including chest pain onset and Emergency Department STEMI team notification ('code' time).
Main Results:
- Women experienced significant delays: Door-to-Code (23 vs. 17 min), Code-to-Balloon (63 vs. 57 min), and overall DTB time (88 vs. 72 min).
- Female gender was an independent predictor of longer DTB time (RGM=1.13, P=.022), alongside hypertension and triage category.
- Factors like maximum ST-elevation and office hours were associated with shorter DTB times.
Conclusions:
- Women face delays in both STEMI diagnosis identification and the subsequent PCI procedure.
- A comprehensive strategy addressing both diagnostic and management aspects of STEMI in women is necessary to improve outcomes.
Background:
A delayed Door-to-Balloon (DTB) time in women with ST-elevation myocardial infarction (STEMI) has been associated with an increased mortality. The objectives of this study were to (a) quantify the components of the delayed DTB time in women and (b) assess the independent effect of gender on DTB time in patients undergoing percutaneous coronary intervention (PCI) for STEMI.
Methods:
Clinical parameters were prospectively collected for 735 STEMI patients undergoing primary PCI from 2006 to 2010, with particular attention to the components of DTB time, including the onset of chest pain and the 'code' notification of the STEMI team by the Emergency Department.
Results:
Women were significantly older with more co-morbidity. Upon hospital arrival they also experienced delays in Door-to-Code (23 vs. 17 min, P=.012), Code-to-Balloon (63 vs. 57 min, P=.001) and thus DTB time (88 vs. 72 min, P=.001). After multivariate adjustment, independent determinants of DTB time included female gender (ratio of geometric means [RGM]=1.13; 95% CI 1.02-1.26; P=.022), hypertension (RGM=1.12, 95% CI 1.02-1.23, P=.014), maximum ST-elevation (RGM=0.97, 95% CI 0.94-0.98, P<.001), office hours (RGM=0.84, 95% CI 0.78-0.92, P<.001) and triage category (RGM=1.23, 95% CI 1.09-1.40, P=.001).
Conclusions:
Women experience delays in identification of the STEMI diagnosis and also in the PCI process. Thus a multifaceted approach addressing both the diagnosis and management of STEMI in women is required.
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