Key result
Women with STEMI experienced longer FMC-to-device times than men (109 vs. 101 min, p=0.001), but had no significant difference in adjusted in-hospital mortality (OR 0.82, 95% CI 0.51-1.34).
Why the study?
Women with STEMI treated with primary PCI historically experience worse in-hospital outcomes than men, prompting evaluation of whether a regional STEMI system reduces these sex-based care gaps.
Does implementation of a regional STEMI system reduce sex-based care gaps in reperfusion times and in-hospital outcomes for patients with acute STEMI?
Cohort (n=1,928)
Does implementation of a regional STEMI system reduce sex-based care gaps in reperfusion times and in-hospital outcomes for patients with acute STEMI?
Odds Ratio: 0.82 (95% CI 0.51–1.34)
p-value: p=0.433
Regionalization of STEMI care alone is insufficient to close sex-based disparities in reperfusion times, though adjusted in-hospital mortality remains similar between men and women.
Regional STEMI systems may not close sex-based reperfusion gaps; leaves open whether targeted interventions can improve equity.
BACKGROUND: Women with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention historically experience worse in-hospital outcomes compared to men. HYPOTHESIS: Implementation of a regional STEMI system will reduce care gaps in reperfusion times and in-hospital outcomes between women and men. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
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Rayner‐Hartley et al. (2021) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=1,928). Female sex vs. Male sex was evaluated on In-hospital mortality (OR 0.82, 95% CI 0.51-1.34, p=0.433). Women with STEMI experienced longer FMC-to-device times than men (109 vs. 101 min, p=0.001), but had no significant difference in adjusted in-hospital mortality (OR 0.82, 95% CI 0.51-1.34).
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