Longer pre-hospital delays and higher mortality in women with STEMI: the e-MUST Registry

Benamer, Hakim; Bataille, Sophie; Tafflet, Muriel; Jabre, P.; Dupas, François; Laborne, François-Xavier; Lapostolle, Frédéric; Lefort, Hugues; Juliard, Jean‐Michel; Letarnec, Jean-Yves; Lamhaut, Lionel; Lebail, Gaelle; Boche, Thévy; Loyeau, Aurélie; Caussin, Christophe; Mapouata, Mireille; Karam, Nicole; Jouven, Xavie; Spaulding, Christian; Lambert, Yves

doi:10.4244/eijv12i5a93

Cited by 45 publications

(38 citation statements)

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“…Additionally, many studies have shown that women with STEMI are more likely to experience a longer delay from symptom onset to reperfusion. 23,25,26 As previously reported, the delay from symptom onset to reperfusion was significantly longer in women with a first STEMI than in similarly affected men in the current study. Sederholm…”

Section: Causes Of Differences In Clinical Outcomes Between the Gensupporting

confidence: 83%

Culprit plaque characteristics in women vs men with a first ST‐segment elevation myocardial infarction: In vivo optical coherence tomography insights

Sun

et al. 2017

Clinical Cardiology

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Section: Causes Of Differences In Clinical Outcomes Between the Gensupporting

confidence: 83%

Culprit plaque characteristics in women vs men with a first ST‐segment elevation myocardial infarction: In vivo optical coherence tomography insights

Sun

et al. 2017

Clinical Cardiology

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“… 11 22 26 In the current study focusing on patient delay from symptom onset to FMC and from symptom onset to diagnosis of STEMI, women delayed 1.5 hours until FMC compared with approximately 1 hour in men. In the total study population, the median delay from symptom onset to FMC of 70 min, and to diagnostic ECG of 110 min, is substantially better than reported in studies from other American and European countries 18 28 29 but still exceeding the recommendations advised by guidelines by several minutes. 30 A study based on the French eMUST registry, including patients with STEMI who have been taken care of by special mobile intensive care units, found in accordance with our data that women waited longer before calling the EMS.…”

Section: Discussioncontrasting

confidence: 56%

“…They also found a very similar delay until calling as we did to any FMC (78 min in women vs 54 min in men, p<0.0001). 18 In the present study, more than 40% of the women compared with 30% of the men waited over 2 hours before seeking medical attention. Reducing patient-caused delay has a great potential to improve the outcomes of patients with STEMI, given that many deaths occur early after symptom onset.…”

Section: Discussionmentioning

confidence: 48%

Gender disparities in first medical contact and delay in ST-elevation myocardial infarction: a prospective multicentre Swedish survey study

Lawesson¹,

Isaksson²,

Ericsson

et al. 2018

BMJ Open

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ObjectivesCompare gender disparities in ST-elevation myocardial infarction (STEMI) regarding first medical contact (FMC) and prehospital delay times and explore factors associated with prehospital delay in men and women separately.DesignCross-sectional study based on medical records and a validated questionnaire. Eligible patients were enrolled within 24 hours after admittance to hospital.SettingPatients were included from November 2012 to January 2014 from five Swedish hospitals with catheterisation facilities 24/7.Participants340 men and 109 women aged between 31 and 95 years completed the survey.Main outcome measuresFMC were divided into five possible contacts: primary healthcare centre by phone or directly, national advisory nurse by phone, emergency medical services (EMS) and emergency room directly. Two parts of prehospital delay times were studied: time from symptom onset to FMC and time from symptom onset to diagnostic ECG.ResultsWomen more often called an advisory nurse as FMC (28% vs 18%, p=0.02). They had a longer delay until FMC, 90 (IQR 39–221) vs 66 (28–161) min, p=0.04 and until ECG, 146 (68–316) vs 103 (61–221) min, p=0.03. Men went to hospital because of believing they were stricken by an MI to a higher extent than women did (25% vs 15%, p=0.04) and were more often recommended to call EMS by bystanders (38% vs 22%, p<0.01). Hesitating about going to hospital and experiencing pain in the stomach/back/shoulders were factors associated with longer delays in women. Believing the symptoms would disappear or interpreting them as nothing serious were corresponding factors in men. In both genders bystanders acting by contacting EMS explained shorter prehospital delays.ConclusionsIn STEMI, women differed from men in FMC and they had longer delays. This was partly due to atypical symptoms and a longer decision time. Bystanders acted more promptly when men than when women fell ill. Public knowledge of MI symptoms, and how to act properly, still seems insufficient.

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“…The time from diagnosis to treatment represents doctors’ responses to the diagnosis of disease. Delay in each segment can lead to longer ischaemic time, which has been found to be associated with higher short-term as well as medium-term to long-term mortality in previous studies 3–5…”

Section: Introductionmentioning

confidence: 96%

Prehospital and in-hospital delays to care and associated factors in patients with STEMI: an observational study in 101 non-PCI hospitals in China

Lin

Xie

et al. 2019

BMJ Open

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ObjectivesTo describe the prehospital and in-hospital delays to care and factors associated with the delays among patients with ST-segment elevation myocardial infarction (STEMI) in non-percutaneous coronary intervention (PCI) hospitals in China.Design, setting and participantsWe analysed data from a large registry-based quality of care improvement trial conducted from 2011 to 2014 among 101 non-PCI hospitals in China. A total of 7312 patients with STEMI were included. Prehospital delay was defined as time from symptom onset to hospital arrival >120 min, first ECG delay as time from arrival to first ECG >10 min, thrombolytic therapy delay as time from first ECG to thrombolytic therapy >10 min and in-hospital delay as time from arrival to thrombolytic therapy >30 min. Logistic regressions with generalised estimating equations were preformed to identify the factors associated with each delay.ResultsThe rates of prehospital delay, first ECG delay, thrombolytic therapy delay and in-hospital delay were 67.1%, 31.4%, 85.8% and 67.8%, respectively. Patients who were female, older than 65 years old, illiterate, farmers, onset during late night and forenoon, had heart rate ≥100 beats/m at admission were more likely and patients who had history of myocardial infarction, hypertension or SBP <90 mm Hg at admission were less likely to have prehospital delay. First ECG delay was more likely to take place in patients arriving on regular hours. Thrombolytic therapy delay rate was lower in patients who had prehospital delay or first ECG delay but higher in those with heart rate ≥100 beats/m at admission. In-hospital delay rate was lower in patients with a history of dyslipidaemia and those who arrived during regular hours.ConclusionChinese patients with STEMI in low medical resource areas suffered severe prehospital and in-hospital delays to care. Future efforts should be made to improve the prehospital delay among vulnerable populations with low socioeconomic status.Trial registration number NCT01398228; Post-results.

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Longer pre-hospital delays and higher mortality in women with STEMI: the e-MUST Registry

Cited by 45 publications

References 0 publications

Culprit plaque characteristics in women vs men with a first ST‐segment elevation myocardial infarction: In vivo optical coherence tomography insights

Culprit plaque characteristics in women vs men with a first ST‐segment elevation myocardial infarction: In vivo optical coherence tomography insights

Gender disparities in first medical contact and delay in ST-elevation myocardial infarction: a prospective multicentre Swedish survey study

Prehospital and in-hospital delays to care and associated factors in patients with STEMI: an observational study in 101 non-PCI hospitals in China

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