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Sex differences in mortality after STEMI driven by delays in hospital presentation
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In patients with STEMI, sex differences in mortality persist and appear to be driven by prehospital delays in hospital presentation, according to findings.
“Controversies abound when examining sex differences in mortality following acute STEMI,” Raffaele Bugiardini, MD, of the department of experimental, diagnostic and specialty medicine at the University of Bologna, Italy, and colleagues wrote. “Some studies point to a disadvantage for women in the setting of STEMI. Others show similar outcome profiles for women and men. Most of these studies, however, focused only on clinical covariates, which should be viewed cautiously, remembering that therapeutic interventions have a large impact on outcomes.”
Bugiardini and colleagues analyzed 6,022 patients with STEMI who had information on time of symptom onset to time of hospital presentation from the International Survey of Acute Coronary Syndromes in Transitional Countries registry from October 2010 to April 2016.
Participants were stratified into time-delay cohorts and the researchers estimated the 30-day risk for all-cause mortality for each cohort.
Men and women had similar delays in seeking care, but women (median, 270 minutes) had a longer overall time from symptom onset to hospital presentation than men (median, 240 minutes).
Woman had an increased risk for 30-day mortality (OR = 1.58, 95% CI, 1.27-1.97) after adjustment for baseline variables.
In patients with STEMI who had delays up to 1 hour from symptom onset to hospital presentation, sex differences were no longer observed (OR = 0.77; 95% CI, 0.29-2.02).
“Reducing the time lag between onset of ischemic symptoms and hospital presentation is of the utmost importance for women because they seem to be more vulnerable to prolonged untreated ischemia,” the researchers wrote. “Further investigations may address the mechanisms that make women more vulnerable.” – by Cassie Homer
Disclosures: The authors report no relevant financial disclosures.
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