Age- and Gender-related Disparities in Primary Percutaneous Coronary Interventions for Acute ST-segment elevation Myocardial Infarction.
BACKGROUND
Previous analyses reported age- and gender-related differences in the provision of cardiac care. The objective of the study was to compare circadian disparities in the delivery of primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) according to the patient's age and gender.


METHODS
We investigated patients included into the Acute Myocardial Infarction in Switzerland (AMIS) registry presenting to one of 11 centers in Switzerland providing primary PCI around the clock, and stratified patients according to gender and age.


RESULTS
A total of 4723 patients presented with AMI between 2005 and 2010; 1319 (28%) were women and 2172 (54%) were ≥65 years of age. More than 90% of patients <65 years of age underwent primary PCI without differences between gender. Elderly patients and particularly women were at increased risk of being withheld primary PCI (males adj. HR 4.91, 95% CI 3.93-6.13; females adj. HR 9.31, 95% CI 7.37-11.75) as compared to males <65 years of age. An increased risk of a delay in door-to-balloon time >90 minutes was found in elderly males (adj HR 1.66 (95% CI 1.40-1.95), p<0.001) and females (adj HR 1.57 (95% CI 1.27-1.93), p<0.001), as well as in females <65 years (adj HR 1.47 (95% CI 1.13-1.91), p = 0.004) as compared to males <65 years of age, with significant differences in circadian patterns during on- and off-duty hours.


CONCLUSIONS
In a cohort of patients with AMI in Switzerland, we observed discrimination of elderly patients and females in the circadian provision of primary PCI.
Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
Thomas
T
Pilgrim
Institute of Social and Preventive Medicine (ISPM) and Clinical Trials Unit, Department of Clinical Research, University of Bern, Bern, Switzerland, Switzerland.
Dik
D
Heg
Institute of Social and Preventive Medicine (ISPM) and Clinical Trials Unit, Department of Clinical Research, University of Bern, Bern, Switzerland, Switzerland.
Kali
K
Tal
Division of Cardiology, St. Anna Hospital, Lucerne, Switzerland.
Paul
P
Erne
AMIS Plus Data Center, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
Dragana
D
Radovanovic
Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
Stephan
S
Windecker
Institute Primary Care and Clinical Epidemiology, University of Bern, Bern, Switzerland.
Peter
P
Jüni
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000008:administration & dosage; D000077144:Clopidogrel; D005260:Female; D005853:Geriatrics; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D012727:Sex Characteristics; D013557:Switzerland; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D016896:Treatment Outcome
D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin