Study Shows Sex Differences in Time to Reperfusion

Women who suffer a myocardial infarction wait much longer than men to call emergency medical services (EMS) and face significantly longer delays getting to a hospital, according to research that will be presented as a part of ACC.15.

The study examined the records of 7,457 European patients enrolled from 2010 to 2014 in the ISACS-TC registry and looked at in-hospital mortality, time delay to call EMS, home-to-hospital delay using EMS, door-to-needle and door-to-balloon times and the overall time to treatment from symptom onset.

Results showed many delays occurred because women waited longer than men to call EMS, with women waiting an average of one hour compared to 45 minutes for men. More than 70 percent of women in the study took longer than an hour to get to a hospital that could treat them, while less than 30 percent of men took that long. Overall delays – the time to call for help and then taken to the right hospital – ranged from five minutes to three days.

Overall, women were nearly twice as likely to die in the hospital compared with men, with in-hospital deaths reported for 12 percent of women and 6 percent of men in the study. The risk of dying remained higher in women even after adjusting for other clinical variables including age, treatments received and cardiovascular risk factors. Women were also less likely to undergo reperfusion therapy compared with men (76 vs. 80.4 percent).

“It is time to look beyond using in-hospital quality initiatives that focus on door-to-balloon or needle time as the only performance measures, especially in women,” said Raffaele Bugiardini, MD, professor of cardiology, University of Bologna, Italy, and lead author of the study. “We must take a step back and look at the overall ‘time to reperfusion’ and find strategies that can favorably impact outcomes in women.”

Keywords: ACC Annual Scientific Session, Cardiovascular Diseases, Emergency Medical Services, Hospital Mortality, Myocardial Infarction, Registries, Risk, Risk Factors, Sex Characteristics, Time-to-Treatment

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