Sex Differences in Times to Reperfusion for STEMI | Journal Scan

Study Questions:

Are there sex-related differences in reperfusion management among young men and women presenting with ST-segment elevation myocardial infarction (STEMI)?

Methods:

Data from the VIRGO (Variations in Recovery: Role of Gender on Outcomes of Young AMI Patients) study were used for the present analysis. This was a prospective cohort of adults, age 18-55 years, enrolled between 2008 and 2012 from 103 hospitals, with a 2:1 ratio of women to men. For the present analysis, only US centers were included. Participants were included if they had abnormal cardiac biomarkers within 24 hours of admission and evidence of electrocardiogram changes, and presented to the enrolling percutaneous coronary intervention (PCI) site or were transferred to the site within 24 hours. Information on clinical and demographic factors, type and time of presenting symptoms, and door-to-needle and balloon time were collected.

Results:

A total of 1,465 patients in the study presented with STEMI, of which 1,238 patients were eligible for reperfusion (93% of eligible patients received reperfusion therapy). Women presented less often with STEMI compared to men (46% vs. 57%, p < 0.001). Most patients received PCI for reperfusion therapy (90%). Women were more likely to present with atypical chest pain or no symptoms compared to men (16% vs. 10%, p = 0.008). Women were more likely to not receive reperfusion therapy compared to men (9% vs. 4%, p = 0.002). Time to PCI was more likely to exceed recommended times in women compared to men (41% vs. 29%; odds ratio [OR], 1.65; 95% confidence interval [CI], 1.27-2.16). This was particularly true for patients transferred to a PCI facility (67% vs. 44%; OR, 2.63; 95% CI, 1.17-4.07). Women were also more likely to experience delays in door-to-needle times (67% vs. 37%; OR, 2.62; 95% CI, 1.23-2.18) compared to men. In multivariate models, adjusting for additional potential confounders including socio-demographic factors and gender, was significantly associated with exceeding reperfusion guidelines (OR, 1.72; 95% CI, 1.28-2.33).

Conclusions:

The investigators concluded that young women presenting with STEMI were less likely to receive reperfusion therapy and more likely to have delays when such therapies were initiated compared to similar-aged men.

Perspective:

These data highlight the need to improve management of women presenting with acute coronary syndromes, in particular young women. As pointed out in Dr. Wenger’s accompanying editorial, improvement in education from community and patients to health professionals will assist in the rapid identification of STEMI in younger patients. Given the increase in cardiovascular risk factors among younger adults, primary prevention in this population is also warranted.

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Prevention, ACS and Cardiac Biomarkers, Interventions and ACS

Keywords: Acute Coronary Syndrome, Biological Markers, Cardiovascular Diseases, Myocardial Infarction, Percutaneous Coronary Intervention, Reperfusion, Electrocardiography, Demography, Primary Prevention, Risk Factors, Prospective Studies


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