title: Presentation, delay, and contraindication to thrombolytic treatment in females and males with myocardial infarction.
abstract: BACKGROUND
  This study seeks to explore gender-relevant factors of medical history, sociodemographics, symptom presentation, and delay on thrombolysis administration (or recorded contraindication) in a sample of men and women with confirmed myocardial infarction (MI).
  
  
  METHODS
  Cross-sectional examination of self and nurse-report data collected in the coronary care unit (CCU) from 12 hospitals across south-central Ontario, Canada. A total of 482 MI patients (347 males, 135 females; 63% response rate) were recruited.
  
  
  RESULTS
  There was no gender difference in the report of chest pain (chi(2)(1) = 3.78, p =.052), or in prehospital delay time (median = 96.5 minutes). Thrombolysis was administered in 158 males (68.4%) and 50 females (50.0%) without reported contraindication. Females (median = 27 minutes) had a significantly longer interval between diagnostic electrocardiogram (ECG) and administration of a thrombolytic than males (median = 22, U = 3,056). No contraindication was indicated for not administering a thrombolytic (i.e., too late, risk of bleed) in approximately 40% of females. In accordance with clinical practice guidelines, thrombolysis was more often administered in participants with a shorter time interval between symptom onset and hospital arrival. For females, thrombolysis was more often administered in younger participants (Kruskal Wallis = 5.88).
  
  
  CONCLUSIONS
  Reducing gender, age, and socioeconomic disparities in access to thrombolysis treatment is imperative. Hospital delays with female cardiac patients may be precluding thrombolysis administration.
authors.affiliation: University Health Network Women's Health Program, ML2-004c, 657 University Avenue, Toronto, Ontario M5G 2N2, Canada. sherry.grace@uhn.on.ca
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
authors.forename: Susan E
authors.initials: SE
authors.lastname: Abbey
authors.forename: Susan
authors.initials: S
authors.lastname: Bisaillon
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Shnek
authors.forename: Jane
authors.initials: J
authors.lastname: Irvine
authors.forename: Donna E
authors.initials: DE
authors.lastname: Stewart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D000075202:Contraindications; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000517:prevention & control; D009864:Ontario; D010343:Patient Admission / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care; D012737:Sex Factors; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D013997:Time Factors; D016387:Women's Health