title: Accessibility to Reperfusion Therapy Among Women with Acute Myocardial Infarction: Impact on Hospital Mortality.
abstract: BACKGROUND
  The available evidence about the effect of gender and/or sex on mortality differences is contradictory. Our aim is to assess the impact of gender on the access to reperfusion therapy in patients with acute coronary syndrome with ST-segment elevation (STEMI), and secondly, to analyze the effect of delay on the differences with regard to hospital mortality.
  
  
  METHODS
  A retrospective cohort study was conducted among consecutive patients with STEMI included in the ARIAM-SEMICYUC registry (2010-2013).
  
  
  RESULTS
  A total of 4816 patients were included (22.09% women). Women were older, presented with longer patient delay (90 vs. 75 minutes, p=0.0066), higher risk profile (GRACE>140: 75.1% vs. 56.05%, p<0.0001), and received less reperfusion therapy (68.8% vs. 74.7%, p<0.0001) with longer total reperfusion time (307 vs. 240 minutes, p<0.0001). Women received less thrombolysis (24.53% vs. 29.98%, p<0.0001) and longer door-to-needle time (85 vs. 70 minutes, p 0.0023). We found no differences regarding primary percutaneous coronary intervention or door-to-balloon time. Women also had higher hospital mortality (crude odds ratio 2.54, 95% confidence interval 1.99-3.26, p<0.0001), which persisted after controlling the effect of patient delay, age, risk (GRACE), and reperfusion (adjusted odds ratio 1.43, 95% confidence interval 1.0-2.06, p=0.0492). Using TIMI or Killip risk scores as risk estimates yielded nonsignificant results.
  
  
  CONCLUSIONS
  Compared with men, women with STEMI have worse access to reperfusion and higher hospital mortality. The impact of the differences in accessibility on mortality gap remains uncertain.
authors.affiliation: 1 Intensive Care and Coronary Unit, Hospital General Universitario de Elche, Elche, Alicante, Spain .
authors.forename: Eva
authors.initials: E
authors.lastname: de-Miguel-Balsa
authors.affiliation: 1 Intensive Care and Coronary Unit, Hospital General Universitario de Elche, Elche, Alicante, Spain .
authors.forename: Jaime
authors.initials: J
authors.lastname: Latour-Pérez
authors.affiliation: 1 Intensive Care and Coronary Unit, Hospital General Universitario de Elche, Elche, Alicante, Spain .
authors.forename: Anna
authors.initials: A
authors.lastname: Baeza-Román
authors.affiliation: 1 Intensive Care and Coronary Unit, Hospital General Universitario de Elche, Elche, Alicante, Spain .
authors.forename: Ana
authors.initials: A
authors.lastname: Llamas-Álvarez
authors.affiliation: 2 Intensive Care and Coronary Unit, Hospital General de Castelló, Castelló, Castelló, Spain .
authors.forename: Javier
authors.initials: J
authors.lastname: Ruiz-Ruiz
authors.affiliation: 3 Intensive Care and Coronary Unit, Hospital Universitario y Politécnico la Fe, Valencia, Spain .
authors.forename: Ma Paz
authors.initials: MP
authors.lastname: Fuset-Cabanes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004562:Electrocardiography; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion; D017063:Outcome Assessment, Health Care; D062645:Percutaneous Coronary Intervention; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult