Delays in emergency angioplasty linked to higher death risk
NEW ORLEANS -- In a heart attack, the saying goes, "Time is muscle." The faster a person gets treated, the better his or her chances of survival and recovery.
But a new study finds that women who have heart attacks wait longer than men to receive an emergency procedure that can re-open clogged blood vessels and restore blood flow to the heart muscle. The study also finds that the longer any patient waits for this treatment, the higher his or her chances are of dying before leaving the hospital.
The procedure, called emergency angioplasty or percutaneous coronary intervention, has the biggest impact if it's performed within 90 minutes of a patient's arrival at the emergency room door.
But the study, based on records from 1,551 heart attack patients who had emergency angioplasty at hospitals in Michigan, shows women on average waited more than 118 minutes before treatment began, compared with 105 minutes for men.
Add to that the 20 extra minutes that it took for the average woman to reach the emergency room after her symptoms began, compared with men, and the result is half an hour more of wasted time and damaged heart muscle.
The results are being presented today at the annual Scientific Sessions of the American Heart Association by University of Michigan cardiologist Mauro Moscucci, M.D., who directs interventional cardiology at the U-M Cardiovascular Center. He will present the data on behalf of the Blue Cross Blue Shield of Michigan Cardiovascular Consortium, a joint research effort designed to study and improve angioplasty care.
In all, patients of both sexes whose angioplasty began within 90 minutes of arrival at the hospital had a 50 percent lower risk of dying in the hospital than those who waited longer. Women were also more than twice as likely as men to die in the hospital. Even when the researchers corrected for the fact that the women in the study had more co-existing health problems, they still found that women were slightly more likely to die before returning home.
"We need to do a better job in making sure that both men and women recognize and react to heart attack symptoms as quickly as possible, and that our emergency medical professionals before and in the hospital work to ensure immediate diagnosis and treatment," says Moscucci. "These delays result in worse outcomes, and there should be no gap between the genders."
Moscucci and his colleagues performed the study by looking at data from 442 women and 1.069 men who had an emergency angioplasty at one of the consortium's hospitals between October 2002 and June 1, 2004. All of the patients had the same kind of heart attack, called acute ST-segment elevation myocardial infarction.
The researchers wanted to see if there were still signs of the gender differences in emergency treatment that had been seen in the days before emergency angioplasty was widespread. They also wanted to see how delays affected in-hospital mortality.
In all, they found that only 25 percent of the female patients underwent emergency angioplasty within the recommended 90 minutes, as compared with 34 percent of men. The 90-minute window of opportunity is often called "door to balloon time" because it measures the time from the patient's arrival at the emergency department to the moment when a tiny balloon is inflated inside a clogged blood vessel to open it up.
During that "door to balloon time," patients must be diagnosed, transferred to the angioplasty area or to a hospital that can do emergency angioplasty, and prepped for the procedure.
Once a patient is ready, doctors insert a long thin tube called a catheter into a blood vessel in his or her groin, and carefully thread it up through the body into the blood vessels near the heart. They're guided by an X-ray imaging system that shows the catheter's progress. When they reach the clogged area they inflate the balloon, opening the blood vessel's clogged passageway. They may also leave behind a tiny scaffold called a stent, to keep the vessel open.
Even after receiving this treatment, one in every 13 women in the study died, compared with one in every 32 men. Those men and women whose door-to-balloon time had been less than 90 minutes were far less likely to die.
The women, on the whole, were older and had more co-existing health problems. This is typical of women heart attack patients nationwide. So, the researchers added those factors, and the increased wait time for angioplasty, to their analysis. Even still, there was a trend -- though not a statistically significant one -- toward increased in-hospital mortality rates for women.
The researchers also confirmed what other studies have found: It takes longer for women to get to the emergency room after they start experiencing symptoms. In the study, the women reported that their symptoms had started on average 105 minutes before they got to the ER, while the average time for men was 85 minutes.
The reasons for this difference aren't clear, but could be due in part to the fact that women tend to have less of the "typical" symptoms of heart attack, such as crushing chest pain and left arm pain. They may also be more likely to attribute those symptoms to something other than a heart attack, in part because they don't realize their own risk for a heart attack.
"Contrary to what our society seems to think, heart attacks can happen to women just as to men," says Moscucci. "We all need to work harder to make sure that women get the same immediate attention and care as men, and that they get it just as quickly."
Source: Eurekalert & othersLast reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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