Women With STEMI Experience Treatment Delays

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Pain-to-ECG time was greater in female vs male patients (108 vs 87 minutes).
Pain-to-ECG time was greater in female vs male patients (108 vs 87 minutes).

Women with ST-segment elevation myocardial infarction (STEMI) often experience delays in receiving treatment, according to research presented at the 66th Annual Scientific Session & Expo of the American College of Cardiology in Washington, DC.

Investigators from the University of Cagliari in Italy studied data from 657 consecutive patients (163 women vs 494 men; mean ages, 68.5 and 62.8 years, respectively; P =.0001) with STEMI to determine the effect of sex on clinicians' decisions to perform reperfusion therapy with primary angioplasty (PPCI).

The following timed intervals were collected for each patient:

  • time from onset of symptoms to first diagnostic electrocardiogram (ECG; pain to ECG)
  • time from hospital arrival to first therapy (door to balloon [DTB])
  • time from the first diagnostic ECG to the first therapeutic intervention (first medical contact-to-balloon time [FMCTB])
  • time from symptom onset to reperfusion (total ischemic time [TIT])

The researchers found that the pain-to-ECG time was greater in female vs male patients (108 vs 87 minutes; P =.04), with female patients often experiencing more than 120 minutes of pain to ECG time (41.1% vs 31.1%; P =.02). Although DTB time was similar among both groups (65 vs 63 minutes, respectively; P =.98), a statistically significant difference in patient management was noted between groups: both FMCTB and TIT were higher among women (100.5 vs 93 minutes [P =.012] and 221 vs 190 minutes [P =.004], respectively).

The researchers concluded that although female sex contributes to prehospital delays to reperfusion, sex is not linked to in-hospital delays.

"These preliminary results address the need to act on psychological factors to improve women's perception of symptoms, and to educating physicians in order to reduce the reperfusion delays in women with STEMI," they wrote. 

Reference

Montisci R, Mulargia E, Congia M, et al. Reperfusion delays in women with STEMI. Abstract 1204-322. Presented at: the 66th Annual Scientific Session & Expo of the American College of Cardiology. March 17-19, 2017; Washington, DC.

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