Cardiology Unit, The Queen Elizabeth Hospital (The Basil Hetzel Institute), Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
Heart Lung Circ. 2013 Oct;22(10):861-9. doi: 10.1016/j.hlc.2013.03.078. Epub 2013 Apr 28.
A delayed Door-to-Balloon (DTB) time in women with ST-elevation myocardial infarction (STEMI) has been associated with an increased mortality. The objectives of this study were to (a) quantify the components of the delayed DTB time in women and (b) assess the independent effect of gender on DTB time in patients undergoing percutaneous coronary intervention (PCI) for STEMI.
Clinical parameters were prospectively collected for 735 STEMI patients undergoing primary PCI from 2006 to 2010, with particular attention to the components of DTB time, including the onset of chest pain and the 'code' notification of the STEMI team by the Emergency Department.
Women were significantly older with more co-morbidity. Upon hospital arrival they also experienced delays in Door-to-Code (23 vs. 17 min, P=.012), Code-to-Balloon (63 vs. 57 min, P=.001) and thus DTB time (88 vs. 72 min, P=.001). After multivariate adjustment, independent determinants of DTB time included female gender (ratio of geometric means [RGM]=1.13; 95% CI 1.02-1.26; P=.022), hypertension (RGM=1.12, 95% CI 1.02-1.23, P=.014), maximum ST-elevation (RGM=0.97, 95% CI 0.94-0.98, P<.001), office hours (RGM=0.84, 95% CI 0.78-0.92, P<.001) and triage category (RGM=1.23, 95% CI 1.09-1.40, P=.001).
Women experience delays in identification of the STEMI diagnosis and also in the PCI process. Thus a multifaceted approach addressing both the diagnosis and management of STEMI in women is required.
ST 段抬高型心肌梗死（STEMI）女性患者的门球时间（DTB）延迟与死亡率增加有关。本研究的目的是：（a）量化女性 DTB 时间延迟的组成部分；（b）评估性别对行 PCI 治疗的 STEMI 患者 DTB 时间的独立影响。
从 2006 年至 2010 年，前瞻性收集了 735 例接受直接 PCI 治疗的 STEMI 患者的临床参数，特别注意 DTB 时间的组成部分，包括胸痛发作和急诊科向 STEMI 团队发出的“代码”通知。
女性年龄明显较大，合并症更多。到达医院后，她们还经历了 Door-to-Code（23 分钟与 17 分钟，P=.012）、Code-to-Balloon（63 分钟与 57 分钟，P=.001）和 DTB 时间（88 分钟与 72 分钟，P=.001）的延迟。多变量调整后，DTB 时间的独立决定因素包括女性性别（几何均数比 [RGM]=1.13；95%CI 1.02-1.26；P=.022）、高血压（RGM=1.12，95%CI 1.02-1.23，P=.014）、最大 ST 段抬高（RGM=0.97，95%CI 0.94-0.98，P<.001）、办公时间（RGM=0.84，95%CI 0.78-0.92，P<.001）和分诊类别（RGM=1.23，95%CI 1.09-1.40，P=.001）。
女性在 STEMI 诊断的确定以及 PCI 过程中都存在延迟。因此，需要采取多方面的方法来解决女性 STEMI 的诊断和管理问题。
