Abstract 11840: Gender and Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction: Symptom to Treatment Delay in Women
Introduction: There is evidence that female patients have a worse prognosis after primary PCI for STEMI compared to male patients.
Hypothesis: The current study sought to investigate gender differences in the setting of primary PCI.
Methods: In two high-volume tertiary centers, all patients undergoing primary PCI between January 2006 and December 2009 were enrolled into a prospective cohort. Mortality rates were obtained through municipality records.
Results: In the three year period a total of 2638 patients were treated, of which 25.4% female (671). On average women were older (66.8 ± 13.0 vs. 61.5 ± 11.7, p<0.001), more frequently had a history of insulin-dependent diabetes mellitus (5.4% vs. 2.3%, p<0.001) as well as malignancy (8.4% vs. 6.0%, p=0.030), renal insufficiency (6.1% vs. 4.0%, p=0.021) and hypertension (46.3 vs. 33.3, p<0.001). Conversely, women had suffered a previous myocardial infarction less frequently (7.8% vs. 12.5%, p=0.001) and were less likely to have a history of PCI (6.6% vs. 9.1%, p=0.044) or bypass surgery (1.3% vs. 2.9%, p=0.026). Furthermore, they were less likely to smoke (41.4% vs. 47.5%, p=0.006) or to suffer from peripheral vascular disease (3.9% vs. 6.0%, p=0.041). The median time between onset of symptoms and balloon inflation was 190 minutes (IQR 140-283.5) in women, compared to 176 minutes (IQR 128-282.75) in men (p=0.015). The diagnosis-to-balloon time and the door-to-balloon time did not differ significantly between men and women. The outcome of seven day mortality was higher in women, 5.2% vs. 2.6% (p=0.001), a difference that was sustained after thirty days (6.7% vs. 3.2%, p<0.001) and one year (8.6% vs. 6.1%, p=0.023). However, age-adjusted hazard ratio for gender and one year mortality was non-significant (1.06, 95% CI 0.77-1.46).
Conclusions: This study demonstrates that time between onset of symptoms and balloon inflation was significantly longer in women, due to the delay before emergency service arrival which is possibly explained by the atypical presentation of myocardial infarction in women and subsequent late recognition by either patient or first line medical care. Heightened public awareness of disease recognition in women might be beneficial.
- © 2011 by American Heart Association, Inc.