Abstract 4537: Gender Differences in Door to Balloon Time: A Single Center Experience
Background: Institutional efforts to decrease door-to-balloon time (DBT) in the treatment of acute ST segment elevation MI (STEMI) have focused on process improvements relating to prompt diagnosis, efficient cath lab transfer and performance of percutaneous intervention to reperfuse the infarct vessel. We sought to determine the influence of gender on three components that together determine DBT.
Methods: We evaluated DBT for 81 consecutive STEMI patients (54 men, 27 women) presenting to the emergency department (ED) over a 23 month period (Feb 07-Dec 08). We measured DBT and each of 3 components of DBT (time from ER arrival to ECG, time from ECG to cath lab arrival and time from cath lab arrival to reperfusion) for each of these patients.
Results: DBT was significantly longer in women than in men (83min vs. 65 min, p=0.005). There was a significantly longer time from ED arrival to first ECG in women. There was also longer times from ECG to cath lab arrival for women which is due to a higher percentage of women (67%) than men (56%) presenting after hours (nights and weekends). When grouped by gender, there was no difference in time from arrival in cath lab to vessel reperfusion.
Conclusions: In a tertiary care community hospital dedicated to process improvements to reduce DBT, we found that gender has a significant influence on DBT and that this is due in part to longer times from ED arrival to first ECG. Time of transfer from cath lab to ECG is largely related to whether patients present during working hours (when the cath lab team is already on site) or after hours. Importantly, gender has no influence on how long it takes to achieve reperfusion once a patient arrives in the cath lab. Education of both the ED staff and women in our community about gender differences in AMI presentation is needed to decrease the time from arrival to first ECG in women presenting with STEMI.