Age- and Gender-related Disparities in Primary Percutaneous Coronary Interventions for Acute ST-segment elevation Myocardial Infarction
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Key result
Elderly women with acute myocardial infarction were at a substantially increased risk of being withheld primary PCI compared to men under 65 years of age (adj. HR 9.31).
Why the study?
Does female gender or older age reduce the likelihood of timely primary PCI in patients with STEMI?
Population
4,723 patients presenting with acute ST-segment elevation myocardial infarction between 2005 and 2010 to one…
Comparison
Female gender and/or older age presenting during… vs Males <65 years of age
Design
Cohort
Follow-up
in-hospital
Authors
Discussion
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Implication
May signal age-sex disparities in AMI reperfusion access; hypothesis-generating and requires prospective confirmation before guiding practice.
Study Design
Type
Observational (n=4,723)
Multicenter
Yes
Structured PICO
Does female gender or older age reduce the likelihood of timely primary PCI in patients with STEMI?
P
Population
4,723 patients with acute ST-segment elevation myocardial infarction presenting to 11 Swiss centers with 24-hour primary PCI facilities between 2005 and 2010.
E
Exposure
Female gender and/or older age (≥65 years) presenting during on- or off-duty hours
C
Comparator
Males <65 years of age
O
Outcome
Provision of primary PCI and delay in door-to-balloon time >90 minutes
Main Result
Hazard Ratio: 9.31 (95% CI 7.37–11.75)
Absolute Event Rate: 49% vs 5%
p-value: p=<0.001
Elderly patients and women with STEMI experience significant delays and lower rates of primary PCI compared to young men, particularly during off-hours, highlighting systemic disparities in acute cardiac care.
Limitations
- Only patients surviving to hospital admission were included, reflecting a selection of patients with a more favorable clinical course.
- Cannot rule out selection bias despite recommended consecutive inclusion.
- Latent differences in baseline characteristics may not be adequately accounted for in the adjusted analysis.
- No information on the type of stent implanted.
- No information on completeness of revascularization during primary PCI.
- Did not investigate whether the documented disparities in management had an effect on clinical outcome.
- Only patients surviving to hospital admission included (selection bias)
- Possible latent differences in baseline characteristics not accounted for in adjusted analysis
- No information on the type of stent implanted
- No information on completeness of revascularization during primary PCI
- Did not investigate whether the documented disparities in management had an effect on clinical outcome
Cite This Study
Pilgrim et al. (2015) conducted an observational in Acute ST-segment elevation Myocardial Infarction (STEMI) (n=4,723). Elderly age (≥65 years) and female gender vs. Males <65 years of age was evaluated on Withheld primary percutaneous coronary intervention (PCI) (HR 9.31, 95% CI 7.37-11.75, p=<0.001). Elderly women with acute myocardial infarction were at a substantially increased risk of being withheld primary PCI compared to men under 65 years of age (adj. HR 9.31).
Topics
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