Background: We suspect female disparities exist in STEMI system time performance metrics. Reducing time sensitive steps in STEMI care reduces time to reperfusion and improves outcomes. A recent AHA statement on acute myocardial infarction in women reports a need for more data on gender differences in STEMI care. In response, we sought to add to the body of knowledge on this subject by examining and sharing gender specific time performance data from 2 large rural STEMI systems of care.
Methods: Data was combined, and retrospectively analyzed for female gender disparities by examining STEMI activation cases from 2 large rural mid-west STEMI systems of care. The Primary Percutaneous Coronary Intervention (PPCI) capable hospitals are located in Duluth, Minnesota, and Fargo, North Dakota. We evaluated 636 consecutive cases from May 2013 through March 2016, and organized them into 3 different settings: PPCI capable hospital emergency departments, non-PCI capable facilities that transfer for PPCI, and EMS field activations transported to a PPCI capable hospital.
Findings: Upon evaluation of all cases, 73% were male, and 27% were female. We found 12 STEMI performance metrics showing longer times for females compared to males, and 5 were statistically significant. These times include: door to ECG time in a PCI capable hospital (7 vs 5 min, p=0.027), patient time spent in the ED of a PPCI capable hospital (46 vs. 43 min, p=0.022), door to ECG in a Non-PCI capable hospital (7 vs 6 min, p=0.030), Non-PCI hospital call until EMS arrival to transport the patient (25 vs 16 min, p=0.037), and symptom onset to 911 call when EMS activates STEMI Alert from the field (45 vs 30 min, p=0.013).
Conclusion: We report data on 12 common STEMI System time performance metrics, which appear to take longer with females, of which 5 were statistically significant. The reasons for these differences are unknown. Further research and education of gender disparities in STEMI system time performance metrics appears warranted.