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Observational Study
. 2018 May 15;71(19):2122-2132.
doi: 10.1016/j.jacc.2018.02.039. Epub 2018 Mar 10.

4-Step Protocol for Disparities in STEMI Care and Outcomes in Women

Affiliations
Free article
Observational Study

4-Step Protocol for Disparities in STEMI Care and Outcomes in Women

Chetan P Huded et al. J Am Coll Cardiol. .
Free article

Abstract

Background: Women with ST-segment elevation myocardial infarction (STEMI) receive suboptimal care and have worse outcomes than men. Whether strategies to reduce STEMI care variability impact disparities in the care and outcomes of women with STEMI is unknown.

Objectives: The study assessed the care and outcomes of men versus women with STEMI before and after implementation of a comprehensive STEMI protocol.

Methods: On July 15, 2014, the authors implemented: 1) emergency department catheterization lab activation; 2) STEMI Safe Handoff Checklist; 3) immediate transfer to an immediately available catheterization lab; and 4) radial first approach to percutaneous coronary intervention (PCI). The authors prospectively studied consecutive patients with STEMI and assessed guideline-directed medical therapy (GDMT) before PCI, median door-to-balloon time (D2BT), in-hospital adverse events, and 30-day mortality stratified by sex before (January 1, 2011 to July 14, 2014; control group) and after (July 15, 2014 to December 31, 2016) implementation of the STEMI protocol.

Results: Of 1,272 participants (68% men, 32% women), women were older with more comorbidities than men. In the control group, women had less GDMT (77% vs. 69%; p = 0.019) and longer D2BT (median 104 min; [interquartile range (IQR): 79 to 133] min vs. 112 [IQR: 85 to 147] min; p = 0.023). Women had more in-hospital stroke, vascular complications, bleeding, transfusion, and death. In the comprehensive 4-step STEMI protocol, sex disparities in GDMT (84% vs. 80%; p = 0.32), D2BT (89 [IQR: 68 to 106] min vs. 91 [IQR: 68 to 114] min; p = 0.15), and in-hospital adverse events resolved. The absolute sex difference in 30-day mortality decreased from the control group (6.1% higher in women; p = 0.002) to the comprehensive 4-step STEMI protocol (3.2% higher in women; p = 0.090).

Conclusions: A systems-based approach to STEMI care reduces sex disparities and improves STEMI care and outcomes in women.

Keywords: STEMI; acute myocardial infarction; door-to-balloon time; percutaneous coronary intervention; sex disparity; women.

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Comment in

  • More Than One Way to Close the Gender Gap.
    Abbott JD, Curtis JP. Abbott JD, et al. J Am Coll Cardiol. 2018 May 15;71(19):2133-2135. doi: 10.1016/j.jacc.2018.03.449. J Am Coll Cardiol. 2018. PMID: 29747833 No abstract available.

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