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Elapsed time from symptom onset to coronary percutaneous revascularization in acute coronary syndromes: is there a gender difference?
Session:
Posters (Sessão 2 - Écran 6) - Enfarte Agudo do Miocárdio 1
Speaker:
Pedro Brás
Congress:
CPC 2023
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.7 Acute Coronary Syndromes - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Pedro Garcia Brás; Luís Morais; Tiago Mendonça; Inês Rodrigues; André Grazina; André Ferreira; Francisco Albuquerque; Ana Raquel Santos; Rúben Ramos; António Fiarresga; Lídia Sousa; Duarte Cacela; Rui Cruz Ferreira
Abstract
<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11.0pt"><span style="background-color:white"><span style="color:black">Introduction: Timely percutaneous coronary intervention (PCI) improves outcomes in patients (P) with ST-segment elevation myocardial infarction (STEMI) or high-risk non-ST-segment elevation (NSTE) acute coronary syndromes (ACS). Female P often have nonspecific symptomatology and thus may present later after symptom onset and therefore be at a higher risk for cardiovascular (CV) complications. </span></span></span></span><br /> <span style="font-size:11.0pt"><span style="background-color:white"><span style="color:black"><span style="background-color:white"><span style="font-family:Arial,Helvetica,sans-serif">The aim of this study was to compare the elapsed time from symptom onset to PCI between female and male ACS P as well as to compare ACS recurrence and CV mortality in a one-month follow-up.</span><br /> <span style="font-family:Arial,Helvetica,sans-serif">Methods: Retrospective evaluation of consecutive P with ACS submitted to PCI enrolled in a single-center prospective ACS registry from 2005 to 2019. Elapsed time from symptom onset to PCI was calculated (in hh:mm) and P were followed up for one month for hospitalization for recurrent ACS or CV mortality. Data was compared between two groups: female P and male P. </span></span><br /> <span style="font-family:Arial,Helvetica,sans-serif"><span style="background-color:white">Results: 4039 P were evaluated, with a mean age of 63±13 years, 28% female gender, female P were older: 68±13 vs 61±12 years, p<0.001, and had an inferior rate of previous ACS: 134 (3.3%) vs 439 (10.9%) P, p=0.013.<br /> The diagnosis at hospital admission, stratified according to gender, was unstable angina in 198 (4.9%) P: 61 (5.5%) female vs 137 (4.7%) male, NSTEMI in 1050 (26%) P: 355 (31.8%) female vs 695 (23.8%) male and STEMI in 2771 (68.6%) P: 695 (62.2%) female vs 2076 (71.1%) male. </span></span></span></span></span></span></span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><span style="background-color:white"><span style="font-size:11.0pt"><span style="background-color:white"><span style="color:black">The elapsed time from symptom onset to PCI was significantly higher in female P(female 08h28 ± 05h56 vs male 06h59 ± 05h38, p<0.001) as well as across the types of ACS: NSTEMI (female 11h23 ± 06h03 vs male 10h33 ± 06h06, p=0.037) and STEMI (female 06h54 ± 05h15 vs male 05h44 ± 04h54, p<0.001), while nonsignificant regarding unstable angina (female 09h03 ± 06h04 vs male 7h51 ± 05h47, p=0.187).</span></span></span><br /> <span style="font-size:11.0pt"><span style="color:black"><span style="background-color:white">There was no significant difference regarding CV complications during hospitalization, including cardiogenic shock: 60 (1.5%) female vs 139 (3.4%) male, p=0.421; mechanical ventilation: 45 (1.1%) female vs 135 (3.3%) male, p=0.440; or cardiac arrest 64 (1.6%) female vs 140 (3.5%) male, p=0.233; although there was a significantly inferior mortality rate in female P: 78 (1.9%) vs 120 (3%) male, p<0.001.</span><br /> <span style="background-color:white">In a 1-month follow-up, female P had a significantly inferior rate of hospitalization for recurrent ACS: female 11 (0.3%) vs male 59 (1.5%) P, HR 0.48 (95% CI 0.25-0.92), p=0.029 and no significant difference in CV mortality: female 12 (0.3%) vs male 36 (0.9%) P, HR 0.87 (95% CI 0.45-1.67), p=0.677.</span><br /> <span style="background-color:white">Conclusion: In a tertiary hospital ACS population of predominantly STEMI P, female P had a significantly higher elapsed time from symptom onset to PCI, with 1 hour and 29 minutes difference (and 1 hour and 10 minutes difference in STEMI P) compared to male P. Female P had a significantly inferior mortality rate and an inferior rate of recurrent ACS.</span></span></span></span></span></span></p>
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