Abstract 21149: Disparity in Treatment Times Between Men and Women in Primary Percutaneous Coronary Intervention
Background: Registry and clinical trial data have shown that women with ST-elevation myocardial infarctions (STEMI) have longer door-to-balloon times (DBT) when compared to men. The educational efforts by national committees with respect to both physician treatment and patient awareness of STEMI have attempted to reduce overall ischemic time and have had a particular emphasis on female patients. However, there is little data to date analyzing whether symptoms-onset-to-balloon-time (SOBT) in STEMI (a variable incorporating both public education [symptom to presentation time] and physician quality of care [DBT]) is longer in women.
Methods: We analyzed 222 consecutive patients who presented to our emergency room over a five-year period with a diagnosis of STEMI and underwent primary percutaneous coronary intervention. Clinical, demographic and angiographic characteristics, including DBT, SOBT, peak creatine kinase (CK) serum levels, and TIMI STEMI risk score were obtained for all patients and compared between men and women.
Results: Of our STEMI cohort, 30% were women. The SOBT was significantly longer in women as compared to men (286 vs. 238 minutes, p=0.03). Women were older at presentation (69 vs. 60 years old, p<0.001) and were higher risk (TIMI STEMI score 4.9 vs. 2.8, p<0.001). There was a trend towards a longer DBT in woman (91 vs. 85 minutes, p=0.1), and there was no difference in peak CK levels (2244 vs. 2326, p=0.8).
Conclusion: Our study demonstrates a significant disparity in symptom-to-treatment time, a more valuable variable in considering overall ischemic time, between men and women. While the DBT difference was 6 minutes between sexes, the SOBT difference was 48 minutes. Although programs designed to improve outcomes in STEMI have narrowed the gender gap with respect to DBT, our data suggests a continued disparity between men and women with respect to overall ischemic time, with much of the delay existing at the pre-hospital level. Continued emphasis should be placed on awareness at the public level with respect to patient education in an attempt to reduce time to presentation, particularly in women.
- © 2010 by American Heart Association, Inc.