Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Royal Columbian Hospital, Division of Cardiology, Fraser Health Authority, Surrey, British Columbia, Canada.
Clin Cardiol. 2021 Aug;44(8):1113-1119. doi: 10.1002/clc.23658. Epub 2021 Jun 8.
Women with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention historically experience worse in-hospital outcomes compared to men.
Implementation of a regional STEMI system will reduce care gaps in reperfusion times and in-hospital outcomes between women and men.
1928 patients (413 women, 21.4%) presented with an acute STEMI between June 2007 and March 2016. The population was divided into an early cohort (n = 728 patients, 2007-May 2011), and a late cohort (n = 1200 patients, June 2011-2016). The primary endpoints evaluated were reperfusion times and in-hospital outcomes.
Compared to men, women experienced significant delays in first medical contact (FMC) to arrival at the emergency room (26.0 vs. 22.0 min, p < 0.001) and FMC-to-device (109 vs. 101 min p = 0.001). Women had higher incidences of post-PCI heart failure and death compared to men (p < 0.05). Following multivariable adjustment, no mortality difference was observed for women versus men (adjusted OR; 0.82; 95% confidence interval [CI], 0.51-1.34; p = 0.433) or for early versus late cohorts (adjusted OR; 1.04; 95% CI, 0.68-1.60; p = 0.856).
Following STEMI regionalization, women continued to experience significantly longer reperfusion times, although there was no difference in adjusted mortality. These results highlight the ongoing disparity of STEMI care between women and men, and suggest that regionalization alone is insufficient to close sex-based care gaps.
接受直接经皮冠状动脉介入治疗的 ST 段抬高型心肌梗死（STEMI）女性患者的住院结局较男性患者差。
实施区域性 STEMI 系统将减少再灌注时间和住院结局方面的女性和男性之间的护理差距。
2007 年 6 月至 2016 年 3 月期间，1928 例急性 STEMI 患者（413 例女性，21.4%）入组。该人群分为早期队列（n=728 例，2007 年 5 月至 2011 年）和晚期队列（n=1200 例，2011 年 6 月至 2016 年）。评估的主要终点是再灌注时间和住院结局。
与男性相比，女性首次医疗接触（FMC）到到达急诊室的时间（26.0 分钟 vs. 22.0 分钟，p<0.001）和 FMC 到器械的时间（109 分钟 vs. 101 分钟，p=0.001）明显延迟。与男性相比，女性接受 PCI 后心力衰竭和死亡的发生率更高（p<0.05）。多变量调整后，女性与男性的死亡率无差异（调整后比值比；0.82；95%置信区间[CI]，0.51-1.34；p=0.433）或早期与晚期队列之间的死亡率无差异（调整后比值比；1.04；95%CI，0.68-1.60；p=0.856）。
STEMI 区域化后，尽管调整死亡率无差异，但女性的再灌注时间仍明显延长。这些结果突出了 STEMI 护理中女性和男性之间持续存在的差异，并表明区域化本身不足以缩小基于性别的护理差距。
