Richard A Brown1, Eduard Shantsila2, Chetan Varma3, Gregory Y H Lip4. 1. From the University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK and. 2. From the University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK and Cardiology Department at Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham and Sandwell Hospital, West Bromwich, UK. 3. Cardiology Department at Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham and Sandwell Hospital, West Bromwich, UK. 4. From the University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK and Cardiology Department at Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham and Sandwell Hospital, West Bromwich, UK richardbrown4@nhs.net.
Abstract
BACKGROUND: Studies have shown higher in-hospital mortality for female patients and ethnic minorities admitted to hospital with acute ST elevation myocardial infarction (STEMI). Pre-hospital delay is thought to be associated with increased in-hospital mortality. AIM: To assess the impact of gender and ethnicity on symptom-to-door time (STDT) in patients presenting with STEMI. DESIGN: Retrospective survey of consecutive patients receiving primary percutaneous coronary intervention between January 2008 and January 2013. A multivariate model was used to adjust for confounders. MAIN OUTCOME MEASURE: Influence of gender and ethnicity on STDT. RESULTS: We analysed 1020 patients (75% male, 263 South Asians, 38 Afro Caribbeans and 719 White Europeans.) There was a trend towards longer unadjusted median STDT in women compared with men (132 min vs. 113 min P = 0.07) which disappeared after correction for age and ethnicity (P = 0.15). There was no gender difference in hospital mortality after correction for age (odds ratio 0.69, 95% confidence interval 0.40-1.18, P = 0.17). On linear regression analysis South Asians showed a trend towards longer STDT than other ethnic groups (P = 0.08) however after adjustment for diabetes there was no association between South Asian ethnicity and hospital mortality. CONCLUSIONS: Neither female gender nor ethnicity were shown to be associated with significant pre-hospital delay.
BACKGROUND: Studies have shown higher in-hospital mortality for female patients and ethnic minorities admitted to hospital with acute ST elevation myocardial infarction (STEMI). Pre-hospital delay is thought to be associated with increased in-hospital mortality. AIM: To assess the impact of gender and ethnicity on symptom-to-door time (STDT) in patients presenting with STEMI. DESIGN: Retrospective survey of consecutive patients receiving primary percutaneous coronary intervention between January 2008 and January 2013. A multivariate model was used to adjust for confounders. MAIN OUTCOME MEASURE: Influence of gender and ethnicity on STDT. RESULTS: We analysed 1020 patients (75% male, 263 South Asians, 38 Afro Caribbeans and 719 White Europeans.) There was a trend towards longer unadjusted median STDT in women compared with men (132 min vs. 113 min P = 0.07) which disappeared after correction for age and ethnicity (P = 0.15). There was no gender difference in hospital mortality after correction for age (odds ratio 0.69, 95% confidence interval 0.40-1.18, P = 0.17). On linear regression analysis South Asians showed a trend towards longer STDT than other ethnic groups (P = 0.08) however after adjustment for diabetes there was no association between South Asian ethnicity and hospital mortality. CONCLUSIONS: Neither female gender nor ethnicity were shown to be associated with significant pre-hospital delay.
Authors: Joshua B Wenner; Graham C Wong; John A Cairns; Michele Perry-Arnesen; Wendy Tocher; Martha Mackay; Joel Singer; Terry Lee; Christopher B Fordyce Journal: CJC Open Date: 2020-01-30