Association of gender on the time of first medical contact primary pci activation for stemi patients at emergency department

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Strategic Health Research and Innovation Plan (PERIS) 2016-2020

Time between first medical contact (FMC) and STEMI activation is a good indicator of the Code STEMI quality. Times of attention are of particular importance in some STEMI subgroups, such as women. Women receive later, inadequate treatment and their mortality rate is higher.

To determine association of gender with the FMC- activation time in STEMI patients admitted to ED.

An observational retrospective study was conducted including all patients admitted to the ED activated as a STEMI between 2013 and 2016. Patients identified as STEMI on a pre-hospital basis, in other hospitals or in primary care centres and activated as code STEMI before being admitted to the hospital were excluded. The main variable was the FMC- activation time, defined as the time between FMC and primary PCI activation. Main clinical variables and comorbidities, in-hospital mortality, hospital stay (in days), and false STEMI positives were also recorded.

A total of 330 patients were included. They were classified by gender: 23.9% (78) women and 76.1% (249) men. Women exhibited more atypical symptoms and ECG changes as compared to men, with abdominal pain (p=0.029), scapular pain (p=0.003), rib pain (p=0.035), back pain (p=0.013) and general poor condition (p=0.008). Delays in the STEMI response time are longer in the case of women, particularly in the following intervals: FMC-activation (p=0.049) and arrival at the Haemodynamic-balloon (p= 0.021).

FMC- activation time are longer in women with atypical presentation. The longest time was detected in women older than 65 years old. This highlights the need to develop strategies to improve STEMI activation time in women.