Clinical Investigation
Acute Ischemic Heart Disease
Temporal trends in patient and treatment delay among men and women presenting with ST-elevation myocardial infarction

https://doi.org/10.1016/j.ahj.2010.09.016Get rights and content

Background

Over the last decade, there have been major changes in the treatment of ST-elevation myocardial infarction (STEMI). Whether these have resulted in changes in sex differences in time to treatment is unknown. We examined temporal trends in time to reperfusion therapy among men and women with STEMI.

Methods

The study includes 2 cohorts of STEMI patients presenting to a large metropolitan region during the periods August 24, 2000, to August 20, 2002 (Cohort1, n = 753), and August 25, 2006, to December 31, 2008 (Cohort2, n = 885).

Results

In both cohorts, compared with men, women were significantly older and had more comorbidities. Rate of emergency medical services use among women increased from 55% in Cohort1 to 66% in Cohort2 (P = .02). Median time from symptom onset to first medical contact was 84 minutes among men and 121 minutes among women (P < .01) in Cohort1 and 59 minutes among men and 81 minutes among women (P < .01) in Cohort2. Median door-to-balloon time was significantly longer among women compared with men in Cohort2. After multivariable adjustment, female sex was associated with a 34% (or 27-minute) increase in time from symptom onset to first medical contact and with a 23% (or 13-minute) increase in time from hospital arrival to reperfusion therapy.

Conclusions

In the last decade, there have been significant reductions in patient and system delay, especially among women. However, women continue to have longer presentation and treatment times, suggesting that there continue to be opportunities for improvement.

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)

  • GibsonC.M. et al.

    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

    (2008)
  • BergerP.B. et al.

    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

    (1999)
  • FuY. et al.

    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

    (2001)
  • GibsonC.M.

    Time is myocardium and time is outcomes

    Circulation

    (2001)
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