Clara L. Fraga et al. Frederico V. B. Macedo Rodrigo T. L. Rocha Domingos Sávio G. Ferreira Filho Bruno R. Nascimento
Ischemic heart disease is the main cause of death worldwide, and its most severe presentation ST-elevation acute myocardial infarction (STEMI), which corresponds to approximately 1/3 of the presentations, and early reperfusion is the main strategy for reducing mortality. Despite broad historical knowledge of gender-related differences in treatment and prognosis of patients with an acute presentation of ischemic heart disease, male individuals, in addition to having earlier access to health systems, are even more likely to undergo a diagnostic coronary angiography and urgent revascularization than women.– The article “Access to Reperfusion Therapies and Mortality in Women with Acute Myocardial Infarction with ST-Segment Elevation: the VICTIM Registry” demonstrates very well this difference in access to reperfusion therapies in the Brazilian scenario. When evaluating 878 patients admitted with STEMI in the northeastern state of Sergipe, Brazil, it was observed that female individuals were less frequently submitted to reperfusion strategies when compared to males, both primary percutaneous coronary interventions (PCI) (44% x 54.5%; p = 0.003) and fibrinolysis (1.7% x 2.6%; p = 0.422). This scenario is in line with data from other previous studies on this topic carried out in different settings (). In the VICTIM registry, higher in-hospital mortality was observed in the female gender (16.1% x 6.7*; p <0.001), probably as a consequence of this lower access to reperfusion therapies. These data are consistent with systematic reviews of the literature on the topic.
Would the delay in calling for help be one of the reasons why women are less frequently submitted to revascularization therapies? The aforementioned study demonstrated that this does not seem to have been the problem in Sergipe, with the time spent calling for help after symptom onset being statistically similar between the genders. However, female patients underwent a greater delay in the primary hospital, until referral to a unit with infrastructure to perform the percutaneous reperfusion (transfer delay). These data differ in part from the findings of a recent study carried out in Italy, in which the mean time from symptom onset to presentation at the hospital was longer for women (280 x 240 minutes), with only 23.2% of women x 29.1 % of men undergoing a delay <120 minutes until hospital admission (p = 0.002). As in the VICTIM study, there was an impact on mortality: in cases with delay ≥120 minutes, mortality rates were higher among women (5.5% x 2.8%), whereas in cases with presentation <120 minutes, mortality was considerably lower and statistically similar between genders (2.0% in women vs. 1.6% in men).
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