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Longer prehospital delays, higher mortality in women with STEMI vs. men
New data from the e-MUST registry highlight longer prehospital delays and a higher rate of in-hospital mortality among women with STEMI compared with men.
Researchers evaluated data collected from the e-MUST registry from 2006 to 2010. The prospective, multicenter registry compiles data on patients with STEMI in the greater Paris region. For this analysis, the researchers analyzed data on 7,397 patients with primary perfusion therapy; of those, 1,557 (21.1%) were women and 5,840 (78.9%) were men.
Compared with men, clinical predictors of worse outcome after STEMI, including older age, cardiogenic shock and diabetes, were significantly higher in women.
The median time between onset of symptoms to call was 2.2 hours for men vs. 2.7 hours for women (P < .0001), onset of symptoms to first medical contact was 2.6 hours for men vs. 3.1 hours for women (P < .0001) and call to first medical contact was 23.6 minutes for men vs. 25.6 minutes for women (P = .02).
The rate of in-hospital mortality was 4.4% for men with STEMI vs. 9.4% for women with STEMI (P < .0001). Increased mortality persisted in women with STEMI after the researchers adjusted for clinical factors, MI location, delays and severity criteria (OR = 1.4; 95% CI, 1.06-1.84).
Primary PCI was performed in 87.9% of women vs. 80.9% of men, and prehospital thrombolysis was performed in 12.1% of women vs. 19.1% of men.
“Emergency physicians and interventional cardiologists must be aware of the increase in early prehospital delays and higher in-hospital mortality in STEMI in women in order to improve management of chest pain in women,” the researchers wrote. “Public education programs targeting women are necessary. STEMI in-hospital mortality can probably be further reduced by lowering vascular complications with an increased use of the radial approach and tailored management of antithrombotic and anticoagulant treatment.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.