Abstract P47: Gender Difference Seems to Disappear with Strategies to Improve Overall Door-to-Balloon Time
Authors: Zhang Yuanyuan , Zhu Daming , Rajamanickam Anitha , Murphy Dan , Hoban Angela , King Susan , Albert Maria , DiSabatino Angela , Weintraub William , Rahman Ehsanur 
Published: March 2022

Background:
Women with STEMI have increased cardiovascular morbidity and mortality possibly due to pre-treatment delay and atypical presentation. In an effort to decrease door to balloon time (D2B),starting 7/2009, a new strategy was implemented in our institution including10 min door to ECG time, 5 min call back by interventional cardiologist, only interventional cardiologist making the decision for PCI and a goal D2B of ≤60 min with real time tracking. With this strategy, the D2B was significantly shortened. We wanted to see what effect this had on the D2B for female patients.

Methods:
We studied the records of 393 consecutive STEMI patients who underwent primary PCI in our institution. Four patients were excluded because ECG or decision time were not clearly documented. Group 1 included patients before the new strategy (7/2008-6/2009), and Group 2 after the new strategy (7/2009-6/2010). D2B were further partitioned into 3 segments:door to ECG time (D2ECG), ECG to decision time (ECG2Dec) and decision to balloon time (Dec2B) . Time intervals were compared for both genders within and between these groups.

Results:
The total D2B decreased with the new strategy from 91.1 min to 80.0 min (p=0.04). In males, neither total D2B nor any time interval decreased significantly. In females, the Dec2B shortened by 6.6 min (p=0.01, Table 1). Before the implementation of the new strategy, the total D2B, D2ECG and Dec2B were all significantly longer in females than in males. After 7/2009, the gender difference in D2B and all time intervals disappeared (Table 2).

Conclusion:
Implementation of rapid revascularization strategy in our hospital appeared to eliminate the gender difference in D2B.

Comparison of time intervals between two groups

Group 1 (Nf=58, N
m
=140)

Group 2(Nf=69, N
m
=122)

P value

D2B
Female
105.6±61.9
86.4±56.0
0.07

Male
85.0±46.7
76.3±52.7
0.16

Door to ECG
Female
14.3±18.0
9.9±11.0
0.10

Male
9.1±10.2
9.0±11.6
0.94

ECG to Decision
Female
33.8±53.8
25.6±44.3
0.35

Male
22.9±41.2
17.3±41.7
0.27

Decision to Balloon
Female
57.6±12.7
51.0±15.4
0.01

Male
53.0±13.7
50.0±15.4
0.10

Data are means ± SD (min).

AVONA or t-test were used where appropriate.

Nf denotes number of females and Nm denotes males.P values are comparisons between group 1 and group 2

Comparison of time intervals between genders

Female(N
1
=58, N
2
=69)

Male (N
1
=140, N
2
=122)

P value

D2B
Group 1
105.6±61.9
85.0±46.7
0.018

Group 2
86.4±56.0
76.3±52.7
0.21

Door to ECG
Group 1
14.3±18.0
9.1±10.2
0.012

Group 2
9.9±11.0
9.0±11.6
0.61

ECG to Decision
Group 1
33.8±53.8
22.9±41.2
0.13

Group 2
25.6±44.3
17.3±41.7
0.20

Decision to Balloon
Group 1
57.6±12.7
53.0±13.7
0.029

Group 2
51.0±15.4
50.0±15.4
0.69

Data are means ± SD (min).

AVONA or t-test were used where appropriate.

N1 denotes number of patients in group1 and N2 denotes group 2.P values are comparisons between females and males.