Gender difference in referral pathway in primary percutaneous coronary intervention

Abstract Introduction Ischaemic heart disease is the single most common cause of death and its frequency is increasing. The mortality in patients presenting with an acute coronary syndrome with ST-elevation (STEMI) is associated with many factors such as the time delay to treatment. Research has suggested that there may be variations in ischemia time between men and women experiencing STEMI. Understanding these gender differences is crucial for improving quality of care and outcomes. Hence, we aim to analyse the response time and delays in the emergent coronary referral pathway for our centre taking gender in consideration. Methods and Results We studied consecutive STEMI patients from 2013 to 2022, admitted in our centre for primary percutaneous coronary angioplasty (PPCI). Time variables included were: patient delay, electrocardiogram (ECG), delay, diagnostic delay, logistic delay, transport delay, home delay, procedure time. Other variables registered were: first medical contact (FMC) to diagnosis time, door-in-door out time, door to wire, diagnosis to wire, FMC to wire and total ischemia time. A total of 1959 patients were included over 9 years, with a median age of 64 ±14 years and with 74% being males. There were no differences regarding median patient (104min vs 90min, p=0,077) or ECG delay (19,5min vs 19min,p=0,998). The median diagnostic delay was higher in female (62min vs 51min, p0,001), conditioning also a higher median delay between FMC to diagnosis (100min vs 90min,p=0,022). We also registered a lower median home delay in men (20min vs 15min, p=0,025), lower FMC to wire (213min vs 184min, p0,001) and a total ischemia times (381,5min vs 295,5min; p0,001) Conclusions First, we found that both genders did not achieve the time frames recommended in the guidelines, suggesting that there is a lot to improve taking STEMI pathway in consideration. We also concluded that besides literature suggesting that women present more often with atypical clinical symptoms, that did not influence either patient or ECG delay. Our findings show a significant delay in STEMI diagnosis in women, which leaded to treatment delays. This finding may be explained by healthcare professional’s underestimation of the risk of heart disease in women, or less pronounced changes in ECG. Hence, when in doubt, a team shared decision is fundamental to improve quality of care and minimize this gender differences.