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Ischemic time during STEMI greater in women vs. men
Women had a greater amount of ischemic time related to STEMI compared with men, which is related to greater patient delays, according to a study published in European Heart Journal: Acute Cardiovascular Care.
“Women and men have a similar amount of pain during a heart attack, but the location may be different,” Matthias R. Meyer, MD, cardiologist at Triemli Hospital in Zurich, said in a press release. “People with pain in the chest and left arm are more likely to think it’s a heart attack, and these are usual symptoms for men. Women often have back, shoulder or stomach pain.”
Acute STEMI in Switzerland
Researchers analyzed data from women (n = 967; mean age, 69 years) and men (n = 3,393; mean age, 61 years) with acute STEMI who received treatment in Zurich between 2000 and 2016. Information collected from the catheterization laboratory included comorbidities, delays and STEMI characteristics. Off-hours were defined as between 5 p.m. and 8 a.m.
Primary outcomes of interest in this study were defined as changes in delays, which included system delay, patient delay and total ischemic time. Patient delay was the time from symptom onset to first medical contact, and system delay was the time from first medical contact to reperfusion in the catheterization laboratory. Total ischemic time was the aggregate of patient and system delays.
Secondary outcome of interest in this study was hospital mortality.
Female sex has independently linked to greater patient delay compared with men (model coefficient = 21.7; 95% CI, 4.1-39.3). This accounted for 12% greater total ischemic time in women vs. men between 2012 and 2016 (215 minutes vs. 192 minutes; P < .001), the researchers wrote.
Median system delay was reduced by 18 minutes in women and 25 minutes in men from 2000-2005 to 2012-2016 (P for trend < .0001).
Predicting delays
Factors that predicted delays in men but not women included stent thrombosis, total occlusion of the culprit artery, presentation during off-hours and a Killip class III or greater, according to the researchers. Although not seen in sex or delays, a Killip class III or greater was independently association with hospital mortality.
“The European Society of Cardiology, the Swiss Heart Foundation, the American Heart Association and other societies and agencies have initiated large, public campaigns to improve women’s awareness of heart disease and to encourage them to seek medical attention at an early stage if typical symptoms occur,” Meyer and colleagues wrote. “However, in contrast to others, our finding that patient delay in female patients remained unchanged for more than a decade (with a small reduction observed only in men) suggests that positive results of public campaigns remain difficult to achieve. However, as patient delay is more than 1.7-fold greater than system delay, it appears self-evident that educating women to call the emergency medical service as soon as possible after the onset of chest discomfort should not be abandoned.” – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.