Sex differences in prehospital delays in patients with st-segment-elevation myocardial infarction undergoing percutaneous coronary intervention
BACKGROUND: Women with ST-segment-elevation myocardial infarction experience delays in reperfusion compared with men with little data on each time component from symptom onset to reperfusion. This study analyzed sex discrepancies in patient delays, prehospital system delays, and hospital delays. MET...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Journal Article |
| Language: | English |
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WILEY
2021
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| Online Access: | http://hdl.handle.net/20.500.11937/93086 |
| _version_ | 1848765693494820864 |
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| author | Stehli, J. Dinh, D. Dagan, M. Duffy, S.J. Brennan, A. Smith, K. Andrew, E. Nehme, Z. Reid, Christopher Lefkovits, J. Stub, D. Zaman, S. |
| author_facet | Stehli, J. Dinh, D. Dagan, M. Duffy, S.J. Brennan, A. Smith, K. Andrew, E. Nehme, Z. Reid, Christopher Lefkovits, J. Stub, D. Zaman, S. |
| author_sort | Stehli, J. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | BACKGROUND: Women with ST-segment-elevation myocardial infarction experience delays in reperfusion compared with men with little data on each time component from symptom onset to reperfusion. This study analyzed sex discrepancies in patient delays, prehospital system delays, and hospital delays. METHODS AND RESULTS: Consecutive patients with ST-segment-elevation myocardial infarction treated with percutaneous coronary intervention across 30 hospitals in the Victorian Cardiac Outcomes Registry (2013-2018) were analyzed. Data from the Ambulance Victoria Data warehouse were used to perform linkage to the Victorian Cardiac Outcomes Registry for all patients transported via emergency medical services (EMS). The primary end point was EMS call-to-door time (prehospital system delay). Secondary end points included symptom-to-EMS call time (patient delay), door-to-device time (hospital delay), 30-day mortality, major adverse cardiovascular events, and major bleeding. End points were analyzed according to sex and adjusted for age, comorbidities, cardiogenic shock, cardiac arrest, and symptom onset time. A total of 6330 (21% women) patients with ST-segment-elevation myocardial infarction were transported by EMS. Compared with men, women had longer adjusted geometric mean symptom-to-EMS call times (47.0 versus 44.0 minutes; P<0.001), EMS call-to-door times (58.1 versus 55.7 minutes; P<0.001), and door-to-device times (58.5 versus 54.9 minutes; P=0.006). Compared with men, women had higher 30-day mortality (odds ratio [OR], 1.38; 95% CI, 1.06-1.79; P=0.02) and major bleeding (OR, 1.54; 95% CI, 1.08-2.20; P=0.02). CONCLUSIONS: Female patients with ST-segment-elevation myocardial infarction experienced excess delays in patient delays, prehospital system delays, and hospital delays, even after adjustment for confounders. Prehospital system and hospital delays resulted in an adjusted excess delay of 10 minutes compared with men. |
| first_indexed | 2025-11-14T11:39:18Z |
| format | Journal Article |
| id | curtin-20.500.11937-93086 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-14T11:39:18Z |
| publishDate | 2021 |
| publisher | WILEY |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-930862023-09-06T03:01:55Z Sex differences in prehospital delays in patients with st-segment-elevation myocardial infarction undergoing percutaneous coronary intervention Stehli, J. Dinh, D. Dagan, M. Duffy, S.J. Brennan, A. Smith, K. Andrew, E. Nehme, Z. Reid, Christopher Lefkovits, J. Stub, D. Zaman, S. Science & Technology Life Sciences & Biomedicine Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology first medical contact ischemic time prehospital delay sex discrepancies ST-segment-elevation myocardial infarction TO-BALLOON TIME CARDIAC OUTCOMES REGISTRY TASK-FORCE GUIDELINES MANAGEMENT GENDER ACTIVATION MORTALITY SYMPTOMS SOCIETY ST‐segment–elevation myocardial infarction first medical contact ischemic time prehospital delay sex discrepancies Aged Aged, 80 and over Australia Emergency Medical Services Female Hospital Mortality Humans Logistic Models Male Middle Aged Percutaneous Coronary Intervention Registries Risk Factors ST Elevation Myocardial Infarction Sex Characteristics Time Factors Time-to-Treatment Treatment Outcome Humans Treatment Outcome Registries Hospital Mortality Logistic Models Risk Factors Sex Characteristics Time Factors Aged Aged, 80 and over Middle Aged Emergency Medical Services Australia Female Male Time-to-Treatment Percutaneous Coronary Intervention ST Elevation Myocardial Infarction BACKGROUND: Women with ST-segment-elevation myocardial infarction experience delays in reperfusion compared with men with little data on each time component from symptom onset to reperfusion. This study analyzed sex discrepancies in patient delays, prehospital system delays, and hospital delays. METHODS AND RESULTS: Consecutive patients with ST-segment-elevation myocardial infarction treated with percutaneous coronary intervention across 30 hospitals in the Victorian Cardiac Outcomes Registry (2013-2018) were analyzed. Data from the Ambulance Victoria Data warehouse were used to perform linkage to the Victorian Cardiac Outcomes Registry for all patients transported via emergency medical services (EMS). The primary end point was EMS call-to-door time (prehospital system delay). Secondary end points included symptom-to-EMS call time (patient delay), door-to-device time (hospital delay), 30-day mortality, major adverse cardiovascular events, and major bleeding. End points were analyzed according to sex and adjusted for age, comorbidities, cardiogenic shock, cardiac arrest, and symptom onset time. A total of 6330 (21% women) patients with ST-segment-elevation myocardial infarction were transported by EMS. Compared with men, women had longer adjusted geometric mean symptom-to-EMS call times (47.0 versus 44.0 minutes; P<0.001), EMS call-to-door times (58.1 versus 55.7 minutes; P<0.001), and door-to-device times (58.5 versus 54.9 minutes; P=0.006). Compared with men, women had higher 30-day mortality (odds ratio [OR], 1.38; 95% CI, 1.06-1.79; P=0.02) and major bleeding (OR, 1.54; 95% CI, 1.08-2.20; P=0.02). CONCLUSIONS: Female patients with ST-segment-elevation myocardial infarction experienced excess delays in patient delays, prehospital system delays, and hospital delays, even after adjustment for confounders. Prehospital system and hospital delays resulted in an adjusted excess delay of 10 minutes compared with men. 2021 Journal Article http://hdl.handle.net/20.500.11937/93086 10.1161/JAHA.120.019938 English http://creativecommons.org/licenses/by-nc/4.0/ WILEY fulltext |
| spellingShingle | Science & Technology Life Sciences & Biomedicine Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology first medical contact ischemic time prehospital delay sex discrepancies ST-segment-elevation myocardial infarction TO-BALLOON TIME CARDIAC OUTCOMES REGISTRY TASK-FORCE GUIDELINES MANAGEMENT GENDER ACTIVATION MORTALITY SYMPTOMS SOCIETY ST‐segment–elevation myocardial infarction first medical contact ischemic time prehospital delay sex discrepancies Aged Aged, 80 and over Australia Emergency Medical Services Female Hospital Mortality Humans Logistic Models Male Middle Aged Percutaneous Coronary Intervention Registries Risk Factors ST Elevation Myocardial Infarction Sex Characteristics Time Factors Time-to-Treatment Treatment Outcome Humans Treatment Outcome Registries Hospital Mortality Logistic Models Risk Factors Sex Characteristics Time Factors Aged Aged, 80 and over Middle Aged Emergency Medical Services Australia Female Male Time-to-Treatment Percutaneous Coronary Intervention ST Elevation Myocardial Infarction Stehli, J. Dinh, D. Dagan, M. Duffy, S.J. Brennan, A. Smith, K. Andrew, E. Nehme, Z. Reid, Christopher Lefkovits, J. Stub, D. Zaman, S. Sex differences in prehospital delays in patients with st-segment-elevation myocardial infarction undergoing percutaneous coronary intervention |
| title | Sex differences in prehospital delays in patients with st-segment-elevation myocardial infarction undergoing percutaneous coronary intervention |
| title_full | Sex differences in prehospital delays in patients with st-segment-elevation myocardial infarction undergoing percutaneous coronary intervention |
| title_fullStr | Sex differences in prehospital delays in patients with st-segment-elevation myocardial infarction undergoing percutaneous coronary intervention |
| title_full_unstemmed | Sex differences in prehospital delays in patients with st-segment-elevation myocardial infarction undergoing percutaneous coronary intervention |
| title_short | Sex differences in prehospital delays in patients with st-segment-elevation myocardial infarction undergoing percutaneous coronary intervention |
| title_sort | sex differences in prehospital delays in patients with st-segment-elevation myocardial infarction undergoing percutaneous coronary intervention |
| topic | Science & Technology Life Sciences & Biomedicine Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology first medical contact ischemic time prehospital delay sex discrepancies ST-segment-elevation myocardial infarction TO-BALLOON TIME CARDIAC OUTCOMES REGISTRY TASK-FORCE GUIDELINES MANAGEMENT GENDER ACTIVATION MORTALITY SYMPTOMS SOCIETY ST‐segment–elevation myocardial infarction first medical contact ischemic time prehospital delay sex discrepancies Aged Aged, 80 and over Australia Emergency Medical Services Female Hospital Mortality Humans Logistic Models Male Middle Aged Percutaneous Coronary Intervention Registries Risk Factors ST Elevation Myocardial Infarction Sex Characteristics Time Factors Time-to-Treatment Treatment Outcome Humans Treatment Outcome Registries Hospital Mortality Logistic Models Risk Factors Sex Characteristics Time Factors Aged Aged, 80 and over Middle Aged Emergency Medical Services Australia Female Male Time-to-Treatment Percutaneous Coronary Intervention ST Elevation Myocardial Infarction |
| url | http://hdl.handle.net/20.500.11937/93086 |