Abstract P105: Influence of sex in the pre-hospital treatment of Acute Coronary Syndrome with ST segment Elevation
The influence of sex in the in-hospital treatment received by patients with ST elevation acute coronary syndrome (STE-ACS) is well known, not so in the pre-hospital setting.
Objective: to ascertain the influence of sex in the pre-hospital treatment of patients with STE-ACS.
Methods: Cohort of consecutive patients diagnosed with and treated for STE-ACS by out-of-hospital emergency teams in Andalusia (Spain).
Period: January 2005 to October 2008. Multiple logistic regression models were build considering which mediators could explain the effect of sex on the outcome variables.
Results: 3115 patients were included, 762 (24.5%) women with a mean age of 61.5±13.1[SD] vs 71.3±13.3 in men (p<0.0001). Women were Killip>1 (18.1% vs 9.8%;p<0.0001), atypical chest pain (ACP) (25.9% vs 17.7%;p<0.0001), ECG difficult to interpret (11.4% vs 8.1%; p=0.005) and delay from onset symptoms to contact emergency system (72 vs 65 minutes; p=0.02). Multivariate models did associate the following variables: less administration of ASA with ACP (p<0.00001;OR=5.1) and Killip>I (p<0.0001;OR=1.9); less administration of analgesia with increasing age (p=0.02;OR=1.08), ACP (p<0.0001;OR=4.3) and women (p<0.009; OR 0.75); less pre-hospital fibrinolysis with greater age (p<0.0001;OR 1.03), grater delay (p<0.0001;OR=1.002), ACP (p<0.0001; OR=2.7), difficult to interpret ECG (p<0.0001;OR=3.9) and women (p=0.002;OR=1.4); less primary PCI with increasing age (p<0.0001;OR=1.027), greater delay (p=0.003;OR=1.001) and ACP (p=0.035;OR=1.76).
Conclusions: Women present a greater mean age, a greater interval between the onset of symptoms and care, more atypical clinical symptoms and a worse initial Killip. This explains a mediator effect on decreasing the probability of being treated with ASA and angioplasty. Nevertheless, sex maintains partially his direct effect in less administration of analgesia and fibrinolysis.