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Sex Differences in Symptom Complexity and Door-to-Balloon Time in Patients With ST-Elevation Myocardial Infarction

John E Brush1, Sarwat I Chaudhry2, Rachel P Dreyer3

  • 1Sentara Healthcare and Eastern Virginia Medical School, Norfolk, Virginia.

The American Journal of Cardiology
|April 16, 2023
PubMed

Insights

Young women with ST-elevation myocardial infarction (STEMI) present with more complex symptoms, potentially delaying critical door-to-balloon times. This complexity, particularly non-chest pain symptoms, is linked to longer treatment delays or no percutaneous coronary intervention.

Area of Science:

  • Cardiology
  • Medical Research

Background:

  • Greater symptom complexity in women compared to men may impede timely recognition of acute ST-elevation myocardial infarction (STEMI).
  • This can lead to delays in crucial door-to-balloon (D2B) times, impacting patient outcomes.

Purpose of the Study:

  • To investigate sex differences in symptom complexity among STEMI patients.
  • To determine the relationship between symptom complexity and D2B times in young and older STEMI patients.

Main Methods:

  • Analysis of data from 1,677 STEMI patients from the VIRGO and SILVER-AMI studies.
  • Symptom complexity defined by number of phenotypes and average symptoms; comparisons using Monte Carlo permutation testing, generalized linear, and logistic regression.

Main Results:

  • Young women exhibited significantly more symptom phenotypes and a higher average number of symptoms than young men.
  • Young women also experienced longer mean D2B times compared to young men.
  • No significant differences in symptom complexity or D2B times were observed between older women and older men.
  • While overall symptom complexity wasn't linked to D2B time, young women reporting more symptom phenotypes had longer D2B times or did not receive percutaneous coronary intervention (PCI).
  • Young women were more likely to report non-chest pain symptoms, which may slow STEMI recognition.

Conclusions:

  • Symptom complexity markers were not universally associated with D2B time in STEMI patients.
  • Increased symptom phenotypes in young women were associated with prolonged D2B time or lack of PCI.
  • The higher prevalence of non-chest pain symptoms in young women may contribute to delayed STEMI recognition and treatment.
  • Further research into symptom clusters is needed to enhance STEMI recognition and improve D2B times in young women.

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