Gender gap in medical care in ST segment elevation myocardial infarction networks: Findings from the Catalan network Codi Infart.
OBJECTIVE
To assess the impact of gender upon the prognosis and medical care in a regional acute ST-elevation myocardial infarction management network.


METHODS
An observational study was made of consecutive patients entered in a prospective database.


METHODS
The Catalan acute ST-elevation myocardial infarction management network.


METHODS
Patients treated between January 2010 and December 2011.


METHODS
Primary angioplasty, thrombolysis or conservative management.


METHODS
Time intervals, proportion and type of reperfusion, overall mortality, and in-hospital complication and overall mortality at 30 days and one year were compared in relation to gender.


RESULTS
Of the 5,831 patients attended by the myocardial infarction network, 4,380 had a diagnosis of acute ST-elevation myocardial infarction, and 961 (21.9%) were women. Women were older (69.8±13.4 vs. 60.6±12.8 years; P<.001), had a higher prevalence of diabetes (27.1 vs. 18.1%, P<.001), Killip class>I (24.9 vs. 17.3%; P<.001) and no reperfusion (8.8 vs. 5.2%; P<.001) versus men. In addition, women had greater delays in medical care (first medical contact-to-balloon: 132 vs. 122min; P<.001, and symptoms onset-to-balloon: 236 vs. 210min; P<.001). Women presented higher percentages of overall in-hospital complications (20.6 vs. 17.4%; P=.031), in-hospital mortality (4.8 vs. 2.6%; P=.001), 30-day mortality (9.1 vs. 4.5%; P<.001) and one-year mortality (14.0 vs. 8.3%; P<.001) versus men. Nevertheless, after multivariate adjustment, no gender differences in 30-day and one-year mortality were observed.


CONCLUSIONS
Despite a higher risk profile and poorer medical management, women present similar 30-day and one-year outcomes as their male counterparts in the context of the myocardial infarction management network.
Servicio de Cardiología, Hospital Clínic, Universidad de Barcelona, Barcelona, España; Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Universidad de La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, España.
D
D
Fernández-Rodríguez
Servicio de Cardiología, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
A
A
Regueiro
Servicio de Cardiología, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
J
J
Cevallos
Servicio de Cardiología, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
X
X
Bosch
Servicio de Cardiología, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
X
X
Freixa
Servicio de Cardiología, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
M
M
Trilla
Servicio de Cardiología, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
S
S
Brugaletta
Servicio de Cardiología, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
V
V
Martín-Yuste
Servicio de Cardiología, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
M
M
Sabaté
Servicio de Cardiología, Hospital Universitario de Canarias, Universidad de La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, España.
F
F
Bosa-Ojeda
Servicio de Cardiología, Hospital Clínic, Universidad de Barcelona, Barcelona, España. Electronic address: masotti@clinic.ub.es.
M
M
Masotti
D000368:Aged; D015897:Comorbidity; D000072700:Conservative Treatment / Q000706:statistics & numerical data; D016208:Databases, Factual; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion / Q000706:statistics & numerical data; D011446:Prospective Studies; D012042:Registries; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D063507:Sexism / Q000706:statistics & numerical data; D013030:Spain / Q000453:epidemiology; D061665:Time-to-Treatment; D016896:Treatment Outcome
D005343:Fibrinolytic Agents
Acute ST-elevation myocardial infarction; Angioplastia primaria; Gender; Género; Infarto agudo de miocardio con elevación del segmento ST; Network; Primary percutaneous coronary intervention; Red