Clinical InvestigationAcute Ischemic Heart DiseaseTemporal trends in patient and treatment delay among men and women presenting with ST-elevation myocardial infarction
Section snippets
Patient population
The patient population consisted of 2 cohorts of STEMI patients presenting to hospitals within the Edmonton region during the periods August 24, 2000, to August 20, 2002 (Cohort1), and August 25, 2006, to December 31, 2008 (Cohort2). The Edmonton region consists of 2 tertiary care hospitals with cardiac catheterization facilities and 3 additional community hospitals. Cohort1 was a prospective observational cohort of consecutive STEMI patients developed to assess the impact of initiating a
Results
Baseline characteristics of 753 patients in Cohort1 and 885 patients in Cohort2 are presented in Table I. Compared with men, women were significantly older and had higher rates of hypertension in both cohorts. The percentage of women arriving by ambulance increased from 55% in Cohort1 to 66% in Cohort2.
Discussion
The availability of 2 cohorts of consecutive patients presenting with STEMI in a large metropolitan area, separated by 4 years (and spanning almost a decade), provided a unique opportunity to examine changes in time to treatment among men and women and to determine whether sex differences persist.
Our study reveals several noteworthy changes in patients' response between Cohort1 (2000-2002) and Cohort2 (2006-2008), especially among women. First, the percentage of women using EMS increased
Conclusions
In this analysis of consecutive STEMI patients over 2 separate periods spanning almost a decade, there have been significant reductions in patient delay, especially among women. System delay has also improved with reductions in door-to-balloon and door-to-needle times. However, despite these improvements, women continue to have significantly longer times to 911 call and first medical contact, and door-to-needle times compared with men, suggesting opportunities for further improvement.
Disclosures
The authors have no disclosures to report.
Acknowledgements
We thank the Epidemiology Coordinating and Research Centre at the University of Alberta for data abstraction and entry.
References (29)
- et al.
Early thrombolytic treatment in acute myocardial infarction reappraisal of the golden hour
Lancet
(1996) - et al.
Door-to-balloon time with primary percutaneous coronary intervention for acute myocardial infarction impacts late cardiac mortality in high-risk patients and patients presenting early after onset of symptoms
J Am Coll Cardiol
(2006) - et al.
Effect of door-to-balloon time on mortality in patients with ST-segment elevation myocardial infarction
J Am Coll Cardiol
(2006) - et al.
Extent of, and factors associated with, delay to hospital presentation in patients with acute coronary disease (the GRACE registry)
Am J Cardiol
(2002) - et al.
Persistence of delays in presentation and treatment for patients with acute myocardial infarction: the GUSTO-I and GUSTO-III experience
Ann Emerg Med
(2002) - et al.
Trends in prehospital delay time and use of emergency medical services for acute myocardial infarction: experience in 4 US communities from 1987-2000
Am Heart J
(2005) - et al.
Patient delay in seeking care for heart attack symptoms: findings from focus groups conducted in five US regions
Prev Med
(2000) - et al.
Unraveling the mysteries of timing: women's perceptions about time to treatment for cardiac symptoms
Soc Sci Med
(2003) - et al.
Gender differences in reasons patients delay in seeking treatment for acute myocardial infarction symptoms
Patient Educ Coun
(2005) - et al.
Feasibility and applicability of paramedic-based prehospital fibrinolysis in a large North American center
Am Heart J
(2006)
Trends in reperfusion strategies, door-to-needle and door-to-balloon times, and in hospital mortality among patients with ST-segment elevation myocardial infarction enrolled in the National Registry of Myocardial Infarction from 1990 to 2006
Am Heart J
Relationship between delay in performing direct coronary angioplasty and early clinical outcome in patients with acute myocardial infarction: results from the global use of strategies to open occluded arteries in acute coronary syndromes (GUSTO-IIB) trial
Circulation
Time to treatment influences the impact of ST-segment resolution on one-year prognosis: insights from the Assessment of the Safety and Efficacy of New Thrombolytic (ASSENT-2) Trial
Circulation
Time is myocardium and time is outcomes
Circulation
Cited by (93)
The Effect of Sex on Door-to-Balloon Time in Patients Presenting With ST-Elevation Myocardial Infarction and Referred for Primary Percutaneous Coronary Intervention: A Systematic Review
2022, Cardiovascular Revascularization MedicineCitation Excerpt :Delays to pPCI not only compromise the feasibility and effectiveness of this front-line treatment [6,7], but for every 30 min delay, one year mortality risk has been shown to increase markedly, by 7.5% [8]. Given the strong link between reperfusion time and patient outcomes [9], it is concerning that many studies report longer D2B times [10–13] and symptom-to-balloon (S2B) times [10,12–14] in females compared to males. However, the literature is mixed, with some studies reporting no such sex difference [15–17], warranting further investigation.
SCAI Expert Consensus Statement on Sex-Specific Considerations in Myocardial Revascularization
2022, Journal of the Society for Cardiovascular Angiography and InterventionsReprint of: Myocardial infarction specificities in woman
2020, Journal Europeen des Urgences et de Reanimation