Does Gender Impact Contact-to-Device Time and Mortality in STEMI Patients?

Female patients with STEMI may experience longer contact-to-device times and have a higher in-hospital mortality rate compared to male patients with STEMI, according to a study published Jan. 11 in the Journal of the American Heart Association.

Robert O. Roswell, MD, FACC, et al., used ACC's ACTION Registry to analyze the outcomes of 102,515 STEMI patients at 760 sites from Jan. 1, 2007 to Dec. 31, 2014. Female STEMI patients only represented 27.2 percent of the study’s population, but had a higher median age and incidence of comorbidities. They were also more likely to be enrolled in Medicare, alert EMS of their symptoms and arrive by ambulance.

Results showed that only 67.5 percent of female patients achieved the target contact-to-device time (≤90 minutes) compared to 75.6 percent of male patients. Furthermore, female patients had longer total ischemic times (161 minutes vs. 145 minutes) and a higher in-hospital mortality rate (4.1 percent vs. 2.0 percent) compared to male STEMI patients.

While improving patient education about the symptoms of an acute coronary syndrome is necessary to lessen symptom onset to contact time, the authors state that “further investigation is needed to mitigate the sex-specific circumstances that exacerbate the risk of mortality for female STEMI patients.”

They add that since the launch of ACC's Door to Balloon (D2B) initiative in 2006, “D2B times have drastically decreased and sex‐related disparities in D2B times have improved. A similar initiative that is focused on standardizing prehospital assessment would likely improve [contact-to-device] times, mitigate disparities based on sex, and improve survival from STEMI.”

Clinical Topics: Acute Coronary Syndromes

Keywords: Acute Coronary Syndrome, Ambulances, American Heart Association, Comorbidity, Female, Hospital Mortality, Incidence, Male, Medicare, Registries, Risk, National Cardiovascular Data Registries, ACTION Registry

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