Sex differences in ST-elevation myocardial infarction activation for patients presenting to the ED - 12/07/16

Doi : 10.1016/j.ajem.2016.06.082

Katherine Choi, MD ^a, Frances S. Shofer, PhD ^b, Angela M. Mills, MD ^b,^{^⁎}
^a Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
^b Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

^⁎Corresponding author at: Department of Emergency Medicine, Ground Floor, Ravdin Bldg, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104-4283. Tel.: +1 215 662 2386, +1 215 260 6594 (Mobile); fax: +1 215 662 3953.Department of Emergency MedicineGround Floor, Ravdin Bldg, Hospital of the University of Pennsylvania3400 Spruce StPhiladelphiaPA19104-4283

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Abstract

Objective

The objective was to determine whether sex was independently associated with door to ST-elevation myocardial infarction (STEMI) activation time. We hypothesized that women are more likely to experience longer delays to STEMI activation than men.

Methods

We conducted a retrospective cohort study of adults ≥18 years who underwent STEMI activation at 3 urban emergency departments between 2010 and 2014. The Wilcoxon rank sum test and logistic regression were used to compare men and women regarding time to activation and proportion with times <15 minutes, respectively.

Results

Of 400 eligible patients, we excluded 61 (15%) with prehospital activations, 44 (11%) arrests, and 3 (1%) transfers. Of the remaining 292 patients, mean age was 61±13 years, 64% were men, 57% were black, and 37% arrived by ambulance. Median door to STEMI activation time was 7.0 minutes longer for women than for men (25.5 vs 18.5 minutes, P=.028). In addition, men were more likely than women to have a door to STEMI activation time <15 minutes (45% vs 28%, P=.006). After adjusting for race, hospital site, Emergency Severity Index triage level, arrival mode, and chief concern of chest pain, the odds of men having STEMI activation times <15 minutes were 1.9 times more likely than women.

Conclusions

Women have longer median door to STEMI activation times than men. A significantly lower proportion of women (28% vs 45%) are treated per American Heart Association guidelines of door to STEMI activation <15 minutes when compared with men, adjusting for confounders. Further investigation may identify possible etiology of bias and potential areas for intervention.

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Plan

Introduction

Materials and methods

Study design and setting

☆	This research was funded through a FOCUS Medical Student Fellowship in Women's Health supported by the Edna G. Kynett Memorial Foundation.
☆☆	Poster presented at Society of Academic Emergency Medicine, San Diego, CA, on May 13, 2015.
★	No conflicts of interest.
★★	KC and AMM conceived the study and designed the trial. KC obtained research funding. KC, AMM, and FSS supervised the conduct of the trial and data collection. FSS provided statistical advice on study design and analyzed the data. KC drafted the manuscript, and all authors contributed substantially to its revision. KC and AMM take responsibility for the paper as a whole.