Evaluation of Gender Differences in Door-to-Balloon Time in ST-Elevation Myocardial Infarction

Dreyer, Rachel P.; Beltrame, John F.; Tavella, Rosanna; Air, Tracy; Hoffmann, Bernadette; Pati, P.; Fiore, David Di; Arstall, Margaret A.; Zeitz, Chris

doi:10.1016/j.hlc.2013.03.078

Cited by 83 publications

(63 citation statements)

References 42 publications

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“…27-29 Our data demonstrate similar delays in processes of care among women. However, we found that the reduction in FMC2B time associated with prehospital ECGs was greater in women, suggesting that performance of a prehospital ECG and early recognition of STEMI are important steps in improving processes of care for women with STEMI.…”

Section: Discussionsupporting

confidence: 62%

Association between prehospital electrocardiogram use and patient home distance from the percutaneous coronary intervention center on total reperfusion time in ST-segment–elevation myocardial infarction patients: A retrospective analysis from the National Cardiovascular Data Registry

Mumma¹,

Kontos²,

Peng³

et al. 2014

American Heart Journal

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Background Current guidelines recommend ≤90 minutes from first medical contact (FMC) to percutaneous coronary intervention (FMC2B) for ST segment elevation myocardial infarction (STEMI) patients. We evaluated the relationship between patient home distance from a percutaneous coronary intervention (PCI) center, prehospital electrocardiogram (ECG) use, and FMC2B time among patients with STEMI. Methods We performed a retrospective cohort study including all STEMI patients in the ACTION®-GWTG™ registry from 7/1/2008 to 9/30/2012 who were transported by ambulance to a PCI center. Patient home distance was defined as the driving distance from the patient's home zip code to the PCI center address. Distance was classified into tertiles, and linear regression was used to characterize the interaction between prehospital ECG use and patient home distance with respect to FMC2B time. Results Of the 29,506 STEMI patients, 19,690 (67%) received a prehospital ECG. The median patient home distance to the PCI center was 11.0 miles among patients with and 9.9 miles among those without a prehospital ECG. Prehospital ECGs were associated with a 10-minute reduction in the FMC2B time (p<0.0001), which was consistent across distance tertiles (11 vs 11 vs 10 minutes). The association between prehospital ECGs and shorter FMC2B was attenuated by 0.8 minutes for every 10 mile increase in distance (interaction p=0.0002). Conclusions Prehospital ECGs are associated with a 10-minute reduction in the FMC2B time. However, patient home distance from a PCI center does not substantially change this association.

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Section: Discussionsupporting

confidence: 62%

Association between prehospital electrocardiogram use and patient home distance from the percutaneous coronary intervention center on total reperfusion time in ST-segment–elevation myocardial infarction patients: A retrospective analysis from the National Cardiovascular Data Registry

Mumma¹,

Kontos²,

Peng³

et al. 2014

American Heart Journal

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“…10,11 Similarly, important sex differences may occur in prehospital interventions for OHCA. In this study, we use the Resuscitation Outcomes Consortium (ROC) Prehospital Resuscitation using an IMpedance valve and Early versus Delayed (PRIMED) database to determine whether sex differences exist in prehospital treatment intervals, procedures, and medications among adults with OHCA.…”

Section: Introductionmentioning

confidence: 99%

Sex differences in the prehospital management of out-of-hospital cardiac arrest

Mumma¹,

Umarov

2016

Resuscitation

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Background Sex differences exist in the diagnosis and treatment of several cardiovascular diseases. Our objective was to determine whether sex differences exist in the use of guideline-recommended treatments in out-of-hospital cardiac arrest (OHCA). Methods We included adult patients with non-traumatic OHCA treated by emergency medical services (EMS) in the Resuscitation Outcomes Consortium Prehospital Resuscitation using an IMpedance valve and Early versus Delayed (ROC PRIMED) database during 2007–2009. Outcomes included prehospital treatment intervals, procedures, and medications. Data were analysed using multivariable linear and logistic regression models that adjusted for sex, age, witnessed arrest, public location, bystander cardiopulmonary resuscitation (CPR), and first known rhythm of ventricular tachycardia/fibrillation. Results We studied 15,584 patients; 64% were male and median age was 68 years (interquartile range 55–80). In multivariable analyses, intervals from EMS dispatch to first rhythm capture (p=0.001) and first EMS CPR (p=0.001) were longer in women than in men. Women were less likely to receive successful intravenous or intraosseous access (OR 0.78, 95% CI 0.71–0.86) but equally likely to receive a successful advanced airway (OR 0.94, 95% CI 0.86–1.02). Women were less likely to receive adrenaline (OR 0.81, 95% CI 0.74–0.88), atropine (OR 0.86, 95% CI 0.80–0.92), and lidocaine or amiodarone (OR 0.68, 95% CI 0.61–0.75). Conclusion Women were less likely than men to receive guideline-recommended treatments for OHCA. The reasons for these differences require further exploration, and EMS provider education and training should specifically address these sex differences in the treatment of OHCA.

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“…These data are different from other results because women usually arrive later in the hospital after the beginning of symptoms. It is believed that women have more atypical symptoms which are often underestimated [35][36][37] . Therefore, we can be satisfied with a personal assessment of our female patients, as well as with an assessment of emergency medical assistance in the field because our women still come to the hospital at the optimum time from the onset of symptoms.…”

Section: Resultsmentioning

confidence: 99%

Gender differences in the clinical presentation, treatment and outcomes of acute myocardial infarction

et al. 2018

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Abstract. Aim: To assess the epidemiological and clinical differences between men and women with acute myocardial infarction (AMI). Patients and methods: This retrospective study included 579 patients (352 men and 221 women) who were hospitalized at the Coronary and postcoronary unit at the General Hospital, Karlovac, Croatia, from 2013 to 2016. We determined the frequency, patient's age, type of symptoms, cardiovascular risk the factors, localization, the time from the onset of symptoms to arrival to the hospital, treatment and complications during the hospitalization. Results: AMI is more frequent in men than in women (P < 0.001) and in men it is significantly more likely to occur at an earlier age than in women (P < 0.001). Men often have typical symptoms while women have atypical symptoms (P = 0.045). More often women have arterial hypertension (P = 0.017) and diabetes (P = 0.025), while men are more often smokers (P = 0.001). There was no difference between the gender regarding hyperlipidemia (P = 0,674). Distribution of localization (P = 0.608), the time required for the arrival to the hospital (P = 0.399) and all the complications of AMI are equal (P = 0.365). Men are more likely to receive PCI treatment, while women get the conservative therapy (P = 0.007). Conclusion: Compared with other studies, our women with AMI have less hyperlipidemia and do not come later to hospital than men. Possible causes are dietary habits and genetics or education and good organization of outpatient emergency medical assistance.Key words: acute myocardial infarction; cardiovascular risk; Croatia; hospital treatment Sažetak. Cilj: Ispitati epidemiološke i kliničke razlike između žena i muškaraca s akutnim infarktom miokarda (AIM). Bolesnici i metode: Ova retrospektivna studija obuhvatila je 579 pacijenata (352 muškarca i 221 ženu) hospitaliziranih u koronarnoj i postkoronarnoj jedinici Opće bolnice Karlovac, Hrvatska, od 2013. do 2016. godine. Utvrdili smo učestalost, dob pacijenata, tip simptoma, kardiovaskularne rizične čimbenike, lokalizaciju, vrijeme od početka simptoma do dolaska u bolnicu, liječenje i komplikacije tijekom hospitalizacije AIM-a. Rezultati: AIM je češći kod muškaraca nego kod žena (P < 0,001) i kod muškaraca je značajno vjerojatnije da će se pojaviti u ranijoj dobi nego kod žena (P < 0,001). Muškarci češće imaju tipične simptome, a žene atipične simptome (P = 0,045). Žene imaju češće arterijsku hipertenziju (P = 0,017) i dijabetes (P = 0,025), dok su muškarci češće pušači (P = 0,001). Hiperlipidemija je podjednako zastupljena u oba spola (P = 0,674). Distribucija lokalizacije (P = 0,608), vrijeme potrebno za dolazak u bolnicu (P = 0,399) i sve komplikacije AIM-a podjednako su česti (P = 0,365). Muškarci se češće liječe invazivnom, a žene konzervativnom terapijom. Zaključak: U usporedbi s drugim istraživanjima naše žene s AIM-om imaju manju učestalost hiperlipidemije i ne dolaze kasnije u bolnicu od muškaraca. Mogući razlozi su prehrambene navike i genetika ili obrazovanje i dobra organizacija izvanbolničk...

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Evaluation of Gender Differences in Door-to-Balloon Time in ST-Elevation Myocardial Infarction

Cited by 83 publications

References 42 publications

Association between prehospital electrocardiogram use and patient home distance from the percutaneous coronary intervention center on total reperfusion time in ST-segment–elevation myocardial infarction patients: A retrospective analysis from the National Cardiovascular Data Registry

Association between prehospital electrocardiogram use and patient home distance from the percutaneous coronary intervention center on total reperfusion time in ST-segment–elevation myocardial infarction patients: A retrospective analysis from the National Cardiovascular Data Registry

Sex differences in the prehospital management of out-of-hospital cardiac arrest

Gender differences in the clinical presentation, treatment and outcomes of acute myocardial infarction

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