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. 2017 Jan 11;6(1):e004521.
doi: 10.1161/JAHA.116.004521.

Impact of Sex and Contact-to-Device Time on Clinical Outcomes in Acute ST-Segment Elevation Myocardial Infarction-Findings From the National Cardiovascular Data Registry

Robert O Roswell  1 , Jordan Kunkes  2 , Anita Y Chen  3 , Karen Chiswell  3 , Sohah Iqbal  2 , Matthew T Roe  3 , Sripal Bangalore  2
Affiliations

Impact of Sex and Contact-to-Device Time on Clinical Outcomes in Acute ST-Segment Elevation Myocardial Infarction-Findings From the National Cardiovascular Data Registry

Robert O Roswell et al. J Am Heart Assoc. .

Abstract

Background: Emergent myocardial reperfusion via primary percutaneous coronary intervention is optimal care for patients presenting with ST-segment elevation myocardial infarction (STEMI). Delays in such interventions are associated with increases in mortality. With the shift in focus to contact-to-device (C2D) time as a new perfusion metric, this study was designed to examine how sex affects C2D time and mortality in STEMI patients.

Methods and results: Clinical data on male and female STEMI patients were extracted and analyzed from the National Cardiovascular Data Registry from July 1, 2008 to December 31, 2014. A total of 102 515 patients were included in the final analytic cohort. The median C2D time in female patients with STEMI was delayed when compared to male patients (80 [65-97] versus 75 [61-90] minutes; P<0.001). The unadjusted mortality was higher in female patients when compared to male patients with STEMI (4.1% versus 2.0%; P<0.001). For every 5-minute increase in C2D time, the adjusted odds ratio for mortality was 1.04 (95% CI, 1.03-1.06) for female patients with STEMI and 1.07 (95% CI, 1.06-1.09) for male patients (P for sex by C2D interaction=0.003).

Conclusions: To date, this is the largest analysis of STEMI patients that measures the impact of the new recommended C2D reperfusion metric on in-hospital mortality. Female STEMI patients have longer C2D times and increased mortality. The disparity can be improved and survival can increase in this high-risk patient cohort by decreasing systems issues that cause increased reperfusion times in female STEMI patients.

Keywords: ST‐segment elevation myocardial infarction; disparities; mortality; reperfusion; sex‐specific.

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Figures

Figure 1
Figure 1
Patient flow. Please note that the exclusions are not all mutually exclusive. STEMI indicates ST‐segment elevation myocardial infarction; PCI, percutaneous coronary intervention.
Figure 2
Figure 2
Contact‐to‐device time in men and women.
Figure 3
Figure 3
Contact‐to‐device times stratified by sex and mode of transportation. EMS indicates emergency medical services; PHT, prehospital transmission of ECG.
Figure 4
Figure 4
Logistic generalized estimating analysis exploring the relationship of contact‐to‐device time and mortality stratified by sex.
See this image and copyright information in PMC

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