Accessibility to Reperfusion Therapy Among Women with Acute Myocardial Infarction: Impact on Hospital Mortality
| Autor: | Eva, de-Miguel-Balsa, Jaime, Latour-Pérez, Anna, Baeza-Román, Ana, Llamas-Álvarez, Javier, Ruiz-Ruiz, Ma Paz, Fuset-Cabanes, Marta, Freire |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Acute coronary syndrome Time Factors Adolescent medicine.medical_treatment Myocardial Infarction Myocardial Reperfusion Hospital mortality Risk profile Health Services Accessibility Electrocardiography Young Adult Reperfusion therapy Percutaneous Coronary Intervention Sex Factors Risk Factors Internal medicine Outcome Assessment Health Care medicine Humans In patient Myocardial infarction Hospital Mortality Registries Aged Retrospective Studies business.industry Editorials Retrospective cohort study General Medicine Thrombolysis Length of Stay Middle Aged medicine.disease Surgery Treatment Outcome Female business |
| Zdroj: | Journal of women's health (2002). 24(11) |
| ISSN: | 1931-843X |
| Popis: | The available evidence about the effect of gender and/or sex on mortality differences is contradictory. Our aim is to assess the impact of gender on the access to reperfusion therapy in patients with acute coronary syndrome with ST-segment elevation (STEMI), and secondly, to analyze the effect of delay on the differences with regard to hospital mortality.A retrospective cohort study was conducted among consecutive patients with STEMI included in the ARIAM-SEMICYUC registry (2010-2013).A total of 4816 patients were included (22.09% women). Women were older, presented with longer patient delay (90 vs. 75 minutes, p=0.0066), higher risk profile (GRACE140: 75.1% vs. 56.05%, p0.0001), and received less reperfusion therapy (68.8% vs. 74.7%, p0.0001) with longer total reperfusion time (307 vs. 240 minutes, p0.0001). Women received less thrombolysis (24.53% vs. 29.98%, p0.0001) and longer door-to-needle time (85 vs. 70 minutes, p 0.0023). We found no differences regarding primary percutaneous coronary intervention or door-to-balloon time. Women also had higher hospital mortality (crude odds ratio 2.54, 95% confidence interval 1.99-3.26, p0.0001), which persisted after controlling the effect of patient delay, age, risk (GRACE), and reperfusion (adjusted odds ratio 1.43, 95% confidence interval 1.0-2.06, p=0.0492). Using TIMI or Killip risk scores as risk estimates yielded nonsignificant results.Compared with men, women with STEMI have worse access to reperfusion and higher hospital mortality. The impact of the differences in accessibility on mortality gap remains uncertain. |
| Databáze: | OpenAIRE |
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