Sex differences in time to primary percutaneous coronary intervention and outcomes in patients presenting with
Michael L Savage1,2, Karen Hay2,3, Dale J Murdoch1,2
1Cardiology Department, The Prince Charles Hospital, Brisbane, Queensland, Australia.
Insights
Despite minor delays in reperfusion for women with ST-segment elevation myocardial infarction (STEMI), contemporary treatment shows no significant sex differences in 30-day or 1-year mortality following primary percutaneous coronary intervention (PCI).
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Services Research
Background:
- Historically, women with ST-elevation myocardial infarction (STEMI) have faced delays in reperfusion and poorer outcomes compared to men.
- Contemporary advancements in STEMI treatment necessitate an evaluation of whether these sex-based disparities persist.
Purpose of the Study:
- To assess contemporary sex differences in the treatment and outcomes of ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
- To determine if historical disparities in reperfusion times and mortality still exist between sexes in the current era of STEMI management.
Main Methods:
- A 10-year retrospective analysis (2010-2019) of consecutive STEMI patients treated with primary PCI at a tertiary referral center.
- Comparison of treatment metrics and outcomes between male and female patient cohorts.
- Primary outcome measures included 30-day and 1-year mortality; secondary measures included STEMI performance indicators like door-to-balloon time.
Main Results:
- While prehospital delays were similar, female STEMI patients experienced longer door-to-balloon and first medical contact-to-balloon (FMCTB) times, with fewer achieving FMCTB < 90 minutes.
- Women had higher rates of initial radial artery access failure compared to men.
- Crucially, no significant sex differences were found in crude or adjusted 30-day or 1-year mortality rates.
Conclusions:
- Minor discrepancies in timely reperfusion measures for STEMI patients persist between sexes.
- Despite these performance measure differences, contemporary primary PCI strategies have effectively eliminated significant sex-based disparities in 30-day and 1-year mortality following STEMI.
Objectives:
We assessed sex differences in treatment and outcomes in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI).
Background:
Historically, delays to timely reperfusion and poorer outcomes have been described in women who suffer STEMI. However, whether these sex discrepancies still exist with contemporary STEMI treatment remains to be evaluated.
Methods:
Consecutive STEMI patients treated with primary PCI patients over a 10-year period (January 1, 2010 to December 31, 2019) from a tertiary referral center were assessed. Comparisons were performed between patient's sex. Primary outcomes were 30-day and 1-year mortality. Secondary outcomes were STEMI performance measures.
Results:
Most patients (n = 950; 76%) were male. Females were on average older (66.8 vs. 61.4 years males; p < 0.001). Prehospital treatment delays did not differ between sexes (54 min [IQR: 44-65] females vs. 52 min [IQR: 43-62] males; p = 0.061). STEMI performance measures (door-to-balloon, first medical contact-to-balloon [FMCTB]) differed significantly with longer median durations in females and fewer females achieving FMCTB < 90 min (28% females vs. 39% males; p < 0.001). Women also experienced greater rates of initial radial arterial access failure (11.3% vs. 3.1%; p < 0.001). However, there were no significant sex differences in crude or adjusted mortality between sexes at 30-days (3.6% male vs. 5.1% female; p = 0.241, adjusted OR: 1.1, 95% CI: 0.5-2.2, p = 0.82) or at 1-year (4.8% male vs. 6.8% female; p = 0.190, adjusted OR: 1.0, (95% CI: 0.5-1.8; p = 0.96).
Conclusion:
Small discrepancies between sexes in measures of timely reperfusion for STEMI still exist. No significant sex differences were observed in either 30-day or 1-year mortality.
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