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Gender gap in medical care in ST segment elevation myocardial infarction networks: Findings from the Catalan network Codi Infart.

Gender gap in medical care in ST segment elevation myocardial infarction networks: Findings from the Catalan network Codi Infart.
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Fernández-Rodríguez D, Regueiro A, Cevallos J, Bosch X, Freixa X, Trilla M, Brugaletta S, Martín-Yuste V, Sabaté M, Bosa-Ojeda F, Masotti M, ,


Fernández-Rodríguez D, Regueiro A, Cevallos J, Bosch X, Freixa X, Trilla M, Brugaletta S, Martín-Yuste V, Sabaté M, Bosa-Ojeda F, Masotti M, , (click to view)

Fernández-Rodríguez D, Regueiro A, Cevallos J, Bosch X, Freixa X, Trilla M, Brugaletta S, Martín-Yuste V, Sabaté M, Bosa-Ojeda F, Masotti M, ,

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Medicina intensiva 2016 09 2841(2) 70-77 pii S0210-5691(16)30136-X
Abstract
OBJECTIVE
To assess the impact of gender upon the prognosis and medical care in a regional acute ST-elevation myocardial infarction management network.

DESIGN
An observational study was made of consecutive patients entered in a prospective database.

SCOPE
The Catalan acute ST-elevation myocardial infarction management network.

PATIENTS
Patients treated between January 2010 and December 2011.

INTERVENTIONS
Primary angioplasty, thrombolysis or conservative management.

VARIABLES OF INTEREST
Time intervals, proportion and type of reperfusion, overall mortality, and in-hospital complication and overall mortality at 30 days and one year were compared in relation to gender.

RESULTS
Of the 5,831 patients attended by the myocardial infarction network, 4,380 had a diagnosis of acute ST-elevation myocardial infarction, and 961 (21.9%) were women. Women were older (69.8±13.4 vs. 60.6±12.8 years; P<.001), had a higher prevalence of diabetes (27.1 vs. 18.1%, P<.001), Killip class>I (24.9 vs. 17.3%; P<.001) and no reperfusion (8.8 vs. 5.2%; P<.001) versus men. In addition, women had greater delays in medical care (first medical contact-to-balloon: 132 vs. 122min; P<.001, and symptoms onset-to-balloon: 236 vs. 210min; P<.001). Women presented higher percentages of overall in-hospital complications (20.6 vs. 17.4%; P=.031), in-hospital mortality (4.8 vs. 2.6%; P=.001), 30-day mortality (9.1 vs. 4.5%; P<.001) and one-year mortality (14.0 vs. 8.3%; P<.001) versus men. Nevertheless, after multivariate adjustment, no gender differences in 30-day and one-year mortality were observed. CONCLUSIONS
Despite a higher risk profile and poorer medical management, women present similar 30-day and one-year outcomes as their male counterparts in the context of the myocardial infarction management network.

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