Sex-related differences in the management of STEMI patients in the Basque Autonomous Community influence of the STEMI network Bihotzez

Abstract

According to the European Society of Cardiology guidelines, ST-segment elevation myocardial infarction (STEMI) networks are mandatory in order to increase primary percutaneous coronary intervention rates and, thereby, decrease mortality rate. However, the effect of the implementation of a STEMI network on women is not well known. We analysed all STEMI patients treated with the network during 2 periods: October 2012-April 2013 and October 2014-April 2014. We measured the mortality rate and the quality time intervals: onset of symptoms to first medical contact (FMC), FMC-PPCI and FMC-thrombolysis. 913 STEMI patients were admitted, 234 women and 639 men. Women were on average 10 years older. No cardiovascular risk factor differences were found in terms of age. Fewer women received any treatment (91.5% vs 95.3%; p=0.002) and treatment delays were longer for treated patients (FMC-PPCI 107 min vs. 95 min; FMC-thrombolysis 35 vs. 30). There were no-differences in mortality rates between men and women. The implementation of a network had a marked impact on the quality of STEMI management, particularly among women; FMC-PPCI decreased by 22 min and FMC-thrombolysis by 2.5 min. The mortality rate of women dropped from 10% to 6.4%). Women suffering from a STEMI are less often treated, and have longer treatment time, even though there were no differences in adjusted mortality. The implementation of a STEMI network allowed an increase in the percentage of treated women and a decrease in treatment delays.