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Title: Impact of Gender and Door-to-Balloon Times on Long-Term Mortality in Patients Presenting With ST-Elevation Myocardial Infarction.
Austin Authors: Murphy, Alexandra C ;Yudi, Matias B ;Farouque, Omar ;Dinh, Diem;Duffy, Stephen J;Brennan, Angela;Reid, Christopher M;Andrianopoulos, Nick;Koshy, Anoop N ;Martin, Lorelle ;Dagan, Misha;Freeman, Melanie;Blusztein, David;Ajani, Andrew E;Clark, David J 
Affiliation: Center of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
University of Melbourne, Melbourne, Australia
School of Public Health, Curtin University, Perth, Western Australia, Australia
Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
Department of Cardiology, Eastern Health, Victoria, Australia
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
Department of Cardiology, Alfred Hospital, Melbourne, Australia
Issue Date: 15-Sep-2019 2019-06-24
Publication information: The American journal of cardiology 2019; 124(6): 833-841
Abstract: Guidelines mandate emergent revascularization in patients presenting with ST-elevation myocardial infarction (STEMI) irrespective of gender. We sought to compare the door-to-balloon times and the impact of timely reperfusion on clinical outcomes in women compared with men presenting with STEMI undergoing primary percutaneous coronary intervention (PPCI). We analyzed data from 6,179 consecutive patients presenting with STEMI undergoing PPCI from the Melbourne Interventional Group registry (2005 to 2017). The primary outcome was long-term mortality. Of the 6,179 patients included 1,258 (20.3%) were female. Female patients were older (69 ± 13 vs 62 ± 12 years; p < 0.001), had more co-morbidities and had longer median symptom-to-balloon times (204 [interquartile range {IQR} 154 to 294] vs 181 [IQR 139 to 258] minutes; p < 0.001) and longer median door-to-balloon times (81 [IQR 55 to 102] vs 75 [IQR 51 to 102)] minutes; p < 0.001), while receiving less drug-eluting stents (39% vs 43%; p = 0.01) and having less radial access for PPCI (15% vs 21%; p < 0.001). Furthermore, female patients received less guideline-directed medical therapy than men with less prescription of aspirin (93.4% vs 95.4%; p = 0.02), statins (96.5% vs 97.6%; p < 0.05), and beta blockers (84.3% vs 89.4%; p < 0.001). Unadjusted in-hospital and 30-day mortality rates were higher in women (8.8% vs 6.2%, 9.8% vs 6.9%; p < 0.001). However, on Cox-proportional hazards modeling, gender was not an independent predictor of long-term mortality (hazards ratio 0.99, 95% confidence interval 0.83 to 1.18; p = 0.92) at a mean follow-up of 4.8 ± 3.5 years. In conclusion, in this large multicenter registry of patients with STEMI, women had longer ischemic times, higher risk profiles, and differing interventional approaches compared with men. Addressing these gender inequalities with early identification of symptoms, adherence to guideline-directed medical therapy, as well as higher rates of radial access and use of drug-eluting stents has the potential to further improve outcomes in women with STEMI.
DOI: 10.1016/j.amjcard.2019.06.008
ORCID: 0000-0002-8741-8631
Journal: The American journal of cardiology
PubMed URL: 31327488
Type: Journal Article
Appears in Collections:Journal articles

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