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J Womens Health (Larchmt). 2015 Nov;24(11):882-8. doi: 10.1089/jwh.2014.5011. Epub 2015 Jun 29.

Accessibility to Reperfusion Therapy Among Women with Acute Myocardial Infarction: Impact on Hospital Mortality.

Collaborators (279)

Ferrer Higueras MJ, Rios Toro JJ, Herrera Rojas D, Loza Vazquez A, Campanario Garcıa A, Sanchez Roman JA, Herrero MM, Ubeda Iglesias A, Margarit Ribas A, Lopez Claver JC, Labarta Monzon L, Escos Orta J, Lander Azcona A, Seron Arbeloa C, Garrido Ramırez de Arellano I, Mallor Bonet T, Zamora Elson M, Marquina Lacueva MI, Civeira Murillo E, Giner Smith LM, Villen LM, Yuste Serrano I, Bernad P, Temino S, Rull V, Valero R, Artesero N, Plumed Serrano E, Joven Lafont J, Moron A, Ibanez Langa JL, Munoz Marco J, Lorente Cortes J, Sanz T, Negra A, Ruiz AL, Gonzalez I, Aguilar AL, Fernandez Salvatierra L, Giner Smith LM, Lafuente Mateo M, Tolon Herrera MJ, Corchero Martın JI, Ruiz Valero F, Noemı R, Garcıa J, Luz Gomez de Travecedo JF, Ramos Castro J, Alonso Fernandez J, Bouchotrouch H, Ortega Saez M, Martın-Macho Gonzalez M, Obando C, Roman Garcıa B, Moradillo Gonzalez S, Sandoval Garzon JJ, de Celis Alvarez A, Ancillo Garcıa P, Monton Rodrıguez AJ, Carbajales Perez C, Vara Arlanzon R, Portugal Rodrıguez E, Puerto Corrales S, Salas CJ, Lopez Gimeno O, Sanz Hernan JJ, Garcıa Garcıa M, Prieto AM, Fraile Gutierrez V, Sanz Hernan JJ, Herran Monge R, Caballero Zirena AC, Martın Rodrıguez C, Portilla Botelho M, Ambros Checa A, Yanez Parareda E, Prieto Valderrey F, Moreno Millan E, Berrade Zubiri JJ, Guıa Rambla C, Garcıa Nogales X, Rodrıguez Yakushev A, Gruartmoner de Vera G, Garcıa Nogales X, Fernandez Trujillo A, Manero Caballero E, Toledo R, Amador Amerigo J, Arauzo Rojo V, Jurado Castro MT, del Castillo Y, Alcoverro Pedrola JM, Fernandez Trujillo A, Canovas Robles J, Medina Ramos L, Dıaz Barranco M, Ortola Vercher V, Sanchez FA, Arias Portaceli L, Abalos Garcıa A, Parejo Montell M, Barrios Perez A, Guglieri Soler A, Fernandez Cabrera J, Ruiz Ruiz J, Arguedas Cervera J, Rodrıguez J, Albert Rodrigo L, Casero Roig P, Altaba Tena S, Ferrandiz A, Madero J, Pircar Rodado E, Alvaro Sanchez R, Manzano Hinojosa P, Onoro Canaveral JJ, Munoz Coronado JJ, Vaya Moscardo J, Fernandez Arroyo P, Carrasco Barea JM, Malogre F, Latour Perez J, de Miguel Balsa E, Pino Izquierdo K, Coves Orts FJ, Picazos Vicente C, Llamas Alvarez A, Martınez Lopez D, Ramos Alzamora D, Herrero Gutierrez E, Marquez de la Plata Panchana A, Fernandez Zapata A, Garcia Ochando L, Martin Osorio LF, Criado Pacheco M, Moyano Ruiz S, Hernandez Garces H, Faus Cerda R, Bellver Bosch L, Talavera Peregrina M, Cortes Navalon C, Portillo Requena C, Laghzaoui F, Ceron Garcıa M, Martınez Juan MD, Simon Simon J, Martınez Penalver L, Molina Sanchez N, Molina Jaime JA, Sanchez Pino MS, Folgado Bisbal JC, Calvo Embuena R, Palomo Navarro M, Langerwerf DM, Carrasco Moreno R, Molla Jimenez C, Anton Pascual JL, TorneroLopez J, Rico Sala M, Garcıa Sanz M, de la Fuente O'Connor E, Oltra Chorda R, Fuset Cabanes MP, Madrid Lopez I, Vacacela Cordova K, Villarreal Tello E, Oliva Gimeno MD, Santarrufina Lluch MC, Barrachina Albert FJ, Lorente Cogollos M, Salinas Reyes GA, Perez Mateos R, Sanchez Garcıa MC, Corchero E, Gallego Curto E, Fernandez Zapata A, Arrasqueta Llanes A, Jimenez Delgado JD, Perez Arriaga M, Vazquez Fuentes F, Antona Dıez M, Borge Rodrıguez G, Pena Luna IM, Guerra Nevado E, Arana Llanderal A, Gonzalez Lar M, Galvan Perez S, Badiola Villa H, Martınez Rodrıguez ML, Alvarez-Lata R, de la Torre Fernandez MJ, Rodrıguez Alvarez-Granada R, Cid Lopez F, Gomez Lopez R, Gonzalez Gonzalez RJ, FernandezGonzalez CJ, Orjales Castro MJ, Pita Garcıa L, Pavıa Pesquera Mde L, Diaz de Antonana V, Martınez Camarero L, Lopez Montoya LA, Cambronero Galache JA, Martınez C, Martınez Dıaz MC, Munoz de la Pena MT, Pintado Delgado Mdel C, Llorente Ruiz B, Arenillas Juanas C, Molina Montero R, Lujan Varas J, Lopez Ramos E, Ortiz de Zarate Ansotegui Y, Manso Alvarez M, Torrejon Perez I, Rubio Regidor M, Fuentes Salazar M, Afamefule Afamefule F, del Nogal Saez F, Meyer E, Flordelis Lasierra JL, Orejas Gallego A, Palma Gamiz MA, Chana Garcıa M, Rico Cepeda P, Martin Delgado MC, de Pablo Hermida AM, Albert de la Cruz P, Cruz Tejedor M, Hernandez Sanchez EM, Garcıa Sanchez E, Nevado Losada E, Zubillaga S, Diez Sainz B, Garcia Torrejon M, Rodriguez Mondejar JJ, Gomez Tello V, Gomez Rosado S, Sanchez-Brunete Palop E, Yague Huertas M, de la Calle Pedrosa N, Garcia Castillo K, Boado Varela V, Florez B, Rengel Jimenez J, Martin Cuadrado M, Ocampos Martınez E, Rodrıguez Junquera M, Velasco Alvarez L, Domınguez Lopez S, Albacete Moreno CL, Nicolas-Franco S, Felices Abad F, Cremades Navalon I, Ortin Katnich L, Mira Sanchez E, Susarte Julia C, Martınez-Lozano Aranaga F, Espinosa Berenguel JL, Gallego Perez B, Vigil Velis M, Centeno Obando JJ, Palazon Sanchez C, Rodrıguez Garcıa A, Fernandez Lozano JA, Dıaz Pastor A, Escudero Garcıa G, Jara Perez P, Casado Mansilla MD, Parraga Ramırez MJ, Quintanilla G, Murcia Hernandez Mdel P, Martınez Quintana ME, Sanchez Camara S, Vılchez Pizarro F, Pascual de la Parte JI, Marın M, Vallespir Cladera C, Freire M.

Author information

1
1 Intensive Care and Coronary Unit, Hospital General Universitario de Elche, Elche, Alicante, Spain .
2
2 Intensive Care and Coronary Unit, Hospital General de Castelló, Castelló, Castelló, Spain .
3
3 Intensive Care and Coronary Unit, Hospital Universitario y Politécnico la Fe, Valencia, Spain .

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.

PMID:
26121263
DOI:
10.1089/jwh.2014.5011
[Indexed for MEDLINE]

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