Comparing the Timeliness of Treatment in Younger vs. Older Patients with ST-Segment Elevation Myocardial Infarction:
Sean M Bloos1, Karampreet Kaur2, Kendrick Lang3
1Master of Public Health Program, Vanderbilt University School of Medicine, Nashville, Tennessee.
Insights
Emergent percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) showed no significant time difference between younger and older adults. However, younger STEMI patients had higher rates of nonwhite race and smoking.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Services Research
Background:
- ST-segment elevation myocardial infarction (STEMI) is more common in older adults, potentially complicating diagnosis in younger individuals.
- Lower incidence in younger populations may present diagnostic challenges, impacting treatment timeliness.
Purpose of the Study:
- To test the hypothesis that emergent percutaneous coronary intervention (PCI) for STEMI is delayed in patients 50 years or younger compared to older patients.
- To compare demographic and clinical characteristics and treatment outcomes between younger and older STEMI patients.
Main Methods:
- A 3-year, 10-center retrospective cohort study of emergency department (ED) STEMI patients aged 18 years and older undergoing emergent PCI.
- Exclusion criteria included pre-ED ECG completion or nondiagnostic initial ECGs.
- The primary outcome was door-to-balloon (D2B) time, with comparisons made between age groups.
Main Results:
- Of 576 STEMI PCI patients, 100 were ≤50 years old and 476 were >50 years old. Median D2B time was similar: 76.5 min (younger) vs. 81.0 min (older) (p=0.91).
- The younger cohort had a higher prevalence of nonwhite races (38% vs. 21%) and current smokers (36% vs. 23%).
- Patients ≤30 years and >80 years had significantly higher odds of D2B delays (>90 min).
Conclusions:
- No statistically significant difference in D2B times was observed between STEMI patients ≤50 years and those >50 years.
- Nonwhite race and smoking were disproportionately represented in the younger STEMI population.
- The very young (≤30 years) and very old (>80 years) subgroups experienced increased odds of D2B delays.
Background:
ST-segment elevation myocardial infarction (STEMI) predominantly affects older adults. Lower incidence among younger patients may challenge diagnosis.
Objectives:
We hypothesize that among patients ≤ 50 years old, emergent percutaneous coronary intervention (PCI) for STEMI is delayed when compared with patients aged > 50 years.
Methods:
This 3-year, 10-center retrospective cohort study included emergency department (ED) STEMI patients ≥ 18 years of age treated with emergent PCI. We excluded patients with an electrocardiogram (ECG) completed prior to ED arrival or a nondiagnostic initial ECG. Our primary outcome was door-to-balloon (D2B) time. We compared characteristics and outcomes among younger vs. older STEMI patients, and among age subgroups.
Results:
There were 576 ED STEMI PCI patients, of whom 100 were ≤ 50 years old and 476 were > 50 years old. Median age was 44 years in the younger cohort (interquartile range [IQR] 41-47) vs. 62 years (IQR 57-70) among older patients. Median D2B time for the younger cohort was 76.5 min (IQR 67.5-102.5) vs. 81.0 min (IQR 65.0-105.5) in the older cohort (p = 0.91). This outcome did not change when ages 40 or 45 years were used to demarcate younger vs. older. The younger cohort had a higher prevalence of nonwhite races (38% vs. 21%; p < 0.001) and those currently smoking (36% vs. 23%; p = 0.005). The very young (≤30 years; 6/576) and very old (>80 years; 45/576) had 5.51 and 2.2 greater odds of delays.
Conclusion:
We found no statistically significant difference in D2B times between patients ≤ 50 years old and those > 50 years old. Nonwhite patients and those who smoke were disproportionately represented within the younger population. The very young and very old had higher odds of D2B times > 90 min.
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