Gender-specific ambulance priority and delays to primary percutaneous coronary intervention: a consequence of the patients’ presentation or the management at the emergency medical communications center?

Abstract

Background Women with ST-elevation myocardial infarction (STEMI) tend to have longer treatment delays than men. This may partly be due to women delaying calling for help, difficulties for the emergency medical communication (EMC) service in interpreting a different constellation of presenting symptoms than men, or gender-specific ambulance delays due to differences in the management by the EMC service. Methods and results We studied the EMC audio logs and medical records of 244 consecutive STEMI patients (65 women and 179 men) who contacted the EMC center at a single hospital directly. Patient demographics, clinical findings, and outcome after primary percutaneous coronary intervention were similar for the 2 genders. More women than men reported chest discomfort and discomfort in other areas of the upper body as debuting symptoms. The combined effects of longer patients delay and system delay led to longer total ischemic time in women (total ischemic time: median [interquartile range] 142 [180] vs 135 [83] minutes, women vs men, P = .024). Despite similar presentation, women had lower priority for emergent ambulance service (78.7% and 89.4% of women vs men, P = .035). Lower priority for ambulance service was associated with longer total ischemic time. Conclusion Despite similar presentation and clinical findings, women with STEMI were given significantly lower priority for emergent ambulance service than men.