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Delayed care and mortality among women and men with myocardial infarction
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نویسنده
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bugiardini r. ,ricci b. ,cenko e. ,vasiljevic z. ,kedev s. ,davidovic g. ,zdravkovic m. ,miličić d. ,dilic m. ,manfrini o. ,koller a. ,badimon l.
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منبع
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journal of the american heart association - 2017 - دوره : 6 - شماره : 8
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چکیده
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Background-women with st-segment-elevation myocardial infarction (stemi) have higher mortality rates than men. we investigated whether sex-related differences in timely access to care among stemi patients may be a factor associated with excess risk of early mortality in women. methods and results-we identified 6022 stemi patients who had information on time of symptom onset to time of hospital presentation at 41 hospitals participating in the isacs-tc (international survey of acute coronary syndromes in transitional countries) registry (nct01218776) from october 2010 through april 2016. patients were stratified into time-delay cohorts. we estimated the 30-day risk of all-cause mortality in each cohort. despite similar delays in seeking care,the overall time from symptom onset to hospital presentation was longer for women than men (median: 270 minutes [range: 130-776] versus 240 minutes [range: 120-600]). after adjustment for baseline variables,female sex was independently associated with greater risk of 30-day mortality (odds ratio: 1.58; 95% confidence interval,1.27-1.97). sex differences in mortality following stemi were no longer observed for patients having delays from symptom onset to hospital presentation of ≤1 hour (odds ratio: 0.77; 95% confidence interval,0.29-2.02). conclusions-sex difference in mortality following stemi persists and appears to be driven by prehospital delays in hospital presentation. women appear to be more vulnerable to prolonged untreated ischemia. © 2017 the authors.
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کلیدواژه
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Acute coronary syndrome; Mortality; Prehospital delay; Women
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آدرس
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department of experimental,diagnostic and specialty medicine,university of bologna, Italy, department of experimental,diagnostic and specialty medicine,university of bologna, Italy, department of experimental,diagnostic and specialty medicine,university of bologna, Italy, clinical center of serbia,medical faculty, Serbia, university clinic of cardiology,medical faculty,university 'ss. cyril and methodius,',skopje,macedonia,university of belgrade, Serbia, clinic for cardiology,clinical center kragujevac,kragujevac,serbia,faculty of medical sciences,university in kragujevac, Serbia, university clinical hospital center bezanijska kosa,faculty of medicine, Russian Federation, department for cardiovascular diseases,university hospital center zagreb,university of zagreb, Croatia, clinical center university of sarajevo, Bosnia and Herzegovina, department of experimental,diagnostic and specialty medicine,university of bologna, Italy, institute of natural sciences,university of physical education,budapest,hungary,department of physiology,new york medical college,valhalla,ny, United States, cardiovascular research institute (iccc),cibercv-institute carlos iii,iib-sant pau,hospital de la santa creu i sant pau,autonomous university of barcelona, Spain
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Authors
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