Impact of the Admission Pathway on the Gender-Related Mortality of Patients With ST-Elevation Myocardial Infarction
Simcha R Meisel1, Ovdat Tal2, Ofer Kobo1
1Heart Institute, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Insights
Women with ST-elevation myocardial infarction (STEMI) have higher mortality, but emergency medical service (EMS) transport equalizes survival. Direct hospital arrival via EMS is crucial for women with STEMI to improve outcomes.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Services Research
Background:
- Women with ST-elevation myocardial infarction (STEMI) experience higher mortality than men, often attributed to age and comorbidities.
- Patient transport pathways for STEMI vary, including direct catheterization lab arrival or emergency department (ED) admission via emergency medical services (EMS) or other means.
Purpose of the Study:
- To investigate the survival gap between men and women with STEMI.
- To assess the impact of admission pathway on treatment times and long-term mortality in STEMI patients.
- To determine if gender disparities in transport influence STEMI outcomes.
Main Methods:
- Analysis of a large nationwide registry of prospectively recorded acute coronary syndrome patients undergoing primary percutaneous coronary interventions.
- Inclusion of 2,740 STEMI patients (464 women, 2,276 men).
- Assessment of gender-specific 5-year mortality rates across different hospital admission pathways (direct to cath lab, ED via EMS, ED via non-EMS).
Main Results:
- Unadjusted 5-year mortality was higher in women (26.4%) than men (15.6%), but this difference disappeared after adjustment.
- Admission pathway significantly impacted survival; direct to catheterization lab or ED via EMS showed similar outcomes for both genders.
- Non-EMS transport to the ED was linked to significantly worse survival, particularly for women.
Conclusions:
- The survival difference in STEMI between men and women is largely explained by factors other than gender itself.
- Women with suspected STEMI benefit significantly from direct transport to the hospital by EMS.
- Exclusive use of EMS for women with STEMI is recommended to mitigate adverse outcomes and improve survival rates.
Abstract:
The mortality of women with ST-elevation myocardial infarction (STEMI) exceeds that of men, supposedly the result of older age and co-morbidities. Patients with STEMI can be transported directly to the catherization lab by the emergency medical service (EMS) or to the emergency department (ED) by the EMS, a regular ambulance, or independently. This raises the question whether gender disparity in the transport of patients with STEMI may affect time to therapy and consequently explain the disparate outcome in men and women with STEMI. We analyzed a large nationwide registry of prospectively-recorded patients with acute coronary syndromes in order to determine if there is a survival gap between men and women with STEMI, and to assess the gender-related effect of admission pathway on time intervals and 5-year mortality. Study population included 2,740 patients with STEMI who underwent primary percutaneous coronary interventions, comprising 464 women (17%, median-70 years) and 2,276 men (83%, median-58 years). The unadjusted 5-year mortality of women was higher compared with men (26.4% vs 15.6%, p = 0.001) but adjustment abrogated this survival difference. Regardless of adjustment, the 5-year mortality of patients with STEMI admitted directly to the catherization lab or to the ED by EMS was similar for men and women but significantly lower in the directly admitted patients (p <0.028). In contrast, admission to the ED by non-EMS was associated with markedly worse survival among women. These results indicate that women suspected of STEMI benefit from transportation by the EMS and should use this pathway exclusively to reach the hospital.
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