Age- and Gender-related Disparities in Primary Percutaneous Coronary Interventions for Acute ST-segment elevation
Thomas Pilgrim1, Dik Heg2, Kali Tal2
1Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
Insights
Elderly patients and women face discrimination in receiving timely primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). This study reveals disparities in PCI delivery based on age and gender, impacting door-to-balloon times.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Previous studies indicate age and gender influence cardiac care delivery.
- Disparities in primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) require further investigation.
Purpose of the Study:
- To compare circadian disparities in primary PCI for AMI based on patient age and gender.
- To identify potential discrimination in PCI access and timeliness.
Main Methods:
- Analysis of patients from the Acute Myocardial Infarction in Switzerland (AMIS) registry.
- Stratification of patients by gender and age (≥65 years and <65 years).
- Inclusion of 11 Swiss centers providing 24/7 primary PCI.
Main Results:
- Elderly patients and women were significantly more likely to be withheld primary PCI compared to younger males.
- Increased risk of delayed door-to-balloon times (>90 minutes) observed in elderly males, elderly females, and younger females compared to younger males.
- Significant circadian patterns in delays were noted during on- and off-duty hours.
Conclusions:
- Discrimination in the circadian provision of primary PCI for AMI exists for elderly patients and females in Switzerland.
- Findings highlight the need for interventions to ensure equitable and timely cardiac care regardless of age or gender.
Background:
Previous analyses reported age- and gender-related differences in the provision of cardiac care. The objective of the study was to compare circadian disparities in the delivery of primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) according to the patient's age and gender.
Methods:
We investigated patients included into the Acute Myocardial Infarction in Switzerland (AMIS) registry presenting to one of 11 centers in Switzerland providing primary PCI around the clock, and stratified patients according to gender and age.
Findings:
A total of 4723 patients presented with AMI between 2005 and 2010; 1319 (28%) were women and 2172 (54%) were ≥65 years of age. More than 90% of patients <65 years of age underwent primary PCI without differences between gender. Elderly patients and particularly women were at increased risk of being withheld primary PCI (males adj. HR 4.91, 95% CI 3.93-6.13; females adj. HR 9.31, 95% CI 7.37-11.75) as compared to males <65 years of age. An increased risk of a delay in door-to-balloon time >90 minutes was found in elderly males (adj HR 1.66 (95% CI 1.40-1.95), p<0.001) and females (adj HR 1.57 (95% CI 1.27-1.93), p<0.001), as well as in females <65 years (adj HR 1.47 (95% CI 1.13-1.91), p = 0.004) as compared to males <65 years of age, with significant differences in circadian patterns during on- and off-duty hours.
Conclusions:
In a cohort of patients with AMI in Switzerland, we observed discrimination of elderly patients and females in the circadian provision of primary PCI.
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