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Women show greater mortality after ST segment elevation myocardial infarction (STEMI). Registries show gender differences in time management. We sought to investigate the gender dependent impact of the optimal first medical contact to primary percutaneous coronary intervention (FMC–PPCI) times of ≤90 min on long term prognosis in STEMI patients undergoing PPCI.
This retrospective cohort study included 1499 consecutive patients with STEMI who underwent PPCI between January 2008 and December 2015. Our primary objective was to quantify the system delays (from FMC-PPCI ≤90 min or >90 min) and to assess its impact on all-cause mortality and major adverse cardiovascular events (MACE; death, recurrent MI, target vessel revascularization, heart failure) during follow-up in a cohort of women. Median follow-up was 2.36 years.
The median time from FMC to PPCI were superior in women (116,3±83) than in men (97,9±67) (p=0,000). Only 51,1% of women had a FMCP-PCI time≤90 min compared to 65% of men (p=0,000). Women with FMCP-PCI ≤ 90 compared to those with FMC-PPI > 90 had lower rates of all-cause mortality (8,5% vs 13,5% , P=0,018) and MACE (13,5% vs 28%, p=0,006) during follow-up. FMC-PPCI >90 min was an independent determinant of MACE in a multivariate analysis (HR IC 95%: 1,557 (1,058-2,292) p=0,025).
FMC-PPCI time≤90 min was associated with better long term prognosis in women. In our registry we found that women had significative higher system delays compared to men. Dedicated studies of specific mechanisms underlying this female disadvantage are mandatory to reduce this gender gap.
CORONARY: Acute Coronary Syndromes