Author + information
- Received February 22, 2018
- Accepted February 25, 2018
- Published online May 7, 2018.
- Chetan P. Huded, MD, MSca,b,
- Michael Johnson, MDa,b,
- Kathleen Kravitz, MBA, RNb,
- Venu Menon, MDb,
- Mouin Abdallah, MDa,b,
- Travis C. Gullett, MDc,
- Scott Hantz, RNb,
- Stephen G. Ellis, MDb,
- Seth R. Podolsky, MDc,
- Stephen W. Meldon, MDc,
- Damon M. Kralovic, DOc,
- Deborah Brosovich, RNb,
- Elizabeth Smith, MPHc,
- Samir R. Kapadia, MDb and
- Umesh N. Khot, MDa,b,∗ ()
- aHeart and Vascular Institute Center for Healthcare Delivery Innovation, Cleveland, Ohio
- bHeart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- cEmergency Services Institute of the Cleveland Clinic, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Umesh N. Khot, Cleveland Clinic Heart and Vascular Institute Center for Healthcare Delivery Innovation, 9500 Euclid Avenue, Desk J2-4, Cleveland, Ohio 44195.
Background Women with ST-segment elevation myocardial infarction (STEMI) receive suboptimal care and have worse outcomes than men. Whether strategies to reduce STEMI care variability impact disparities in the care and outcomes of women with STEMI is unknown.
Objectives The study assessed the care and outcomes of men versus women with STEMI before and after implementation of a comprehensive STEMI protocol.
Methods On July 15, 2014, the authors implemented: 1) emergency department catheterization lab activation; 2) STEMI Safe Handoff Checklist; 3) immediate transfer to an immediately available catheterization lab; and 4) radial first approach to percutaneous coronary intervention (PCI). The authors prospectively studied consecutive patients with STEMI and assessed guideline-directed medical therapy (GDMT) before PCI, median door-to-balloon time (D2BT), in-hospital adverse events, and 30-day mortality stratified by sex before (January 1, 2011 to July 14, 2014; control group) and after (July 15, 2014 to December 31, 2016) implementation of the STEMI protocol.
Results Of 1,272 participants (68% men, 32% women), women were older with more comorbidities than men. In the control group, women had less GDMT (77% vs. 69%; p = 0.019) and longer D2BT (median 104 min; [interquartile range (IQR): 79 to 133] min vs. 112 [IQR: 85 to 147] min; p = 0.023). Women had more in-hospital stroke, vascular complications, bleeding, transfusion, and death. In the comprehensive 4-step STEMI protocol, sex disparities in GDMT (84% vs. 80%; p = 0.32), D2BT (89 [IQR: 68 to 106] min vs. 91 [IQR: 68 to 114] min; p = 0.15), and in-hospital adverse events resolved. The absolute sex difference in 30-day mortality decreased from the control group (6.1% higher in women; p = 0.002) to the comprehensive 4-step STEMI protocol (3.2% higher in women; p = 0.090).
Conclusions A systems-based approach to STEMI care reduces sex disparities and improves STEMI care and outcomes in women.
- acute myocardial infarction
- door-to-balloon time
- sex disparity
- percutaneous coronary intervention
The funding source was unrestricted philanthropic support to the Heart and Vascular Institute Center for Healthcare Delivery Innovation, Cleveland Clinic. The funding source had no role in the design or conduct of the study; collection, management, analyses, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. Dr. Ellis has served as a consultant for Abbott Vascular, Boston Scientific, and Medtronic. Dr. Khot has served as a consultant for AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 22, 2018.
- Accepted February 25, 2018.
- 2018 The Authors