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Ischaemia-reperfusion time differences in ST-elevation myocardial infarction in very young patients: a cohort study
Pablo Juan-Salvadores1,2, Luis Mariano De La Torre Fonseca3, Beatriz Calderon-Cruz4
1Cardiology, Hospital Alvaro Cunqueiro, Vigo, Spain pablo.juan.salvadores@sergas.es marianotorre33@gmail.com.
Insights
Young patients with ST-elevation myocardial infarction (STEMI) receive faster diagnoses. However, healthcare delays are linked to major adverse cardiac events (MACE) and reduced survival in all STEMI patients.
Area of Science:
- Cardiology
- Emergency Medicine
Background:
- ST-elevation myocardial infarction (STEMI) is a common presentation in younger individuals.
- Timely medical intervention is critical for improving patient prognosis in STEMI cases.
Purpose of the Study:
- To compare ischemia-reperfusion times between STEMI patients aged ≤40 and >40 years.
- To investigate the association of these times with long-term mortality and major adverse cardiac events (MACE).
Main Methods:
- A retrospective, multicenter cohort study involving 6799 STEMI patients.
- Patients were divided into two groups: ≤40 years and >40 years.
- Analysis focused on diagnosis times, delay factors, and MACE occurrence.
Main Results:
- Younger STEMI patients achieved earlier electrocardiographic diagnoses.
- Delays in diagnosis were associated with female sex, dyspnea, and non-hemodynamic hospital presentations.
- Healthcare delays were identified as a risk factor for MACE within the first year.
Conclusions:
- Younger STEMI patients generally receive quicker diagnoses compared to older counterparts.
- Delays in healthcare are a significant factor contributing to MACE and poorer survival rates in STEMI patients.
Introduction:
ST-elevation myocardial infarction (STEMI) is one of the most prevalent presentations in young patients. It is essential to emphasise that each minute of delay in providing medical care is negatively correlated to the patient's prognosis. The present study was carried out to evaluate the ischaemia-reperfusion times in patients ≤40 years of age versus individuals >40 years of age and their association with mortality and major adverse cardiac event (MACE) over the long term.
Methods:
A retrospective, multicentre cohort study was carried out in 6799 patients diagnosed with STEMI. Two groups were established: patients diagnosed with STEMI and aged >40 years, and patients diagnosed with STEMI and aged ≤40 years.
Results:
The patients in the young group had a significantly sooner electrocardiographic diagnosis than the patients >40 years of age. A delay was observed in females, with a relative risk (RR) of 1.21 (95% CI 1.13 to 1.30) (p<0.001). Presenting dyspnoea (RR 1.76, 95% CI 1.5 to 2.06) (p<0.001) or going to a hospital without haemodynamics (RR 1.55, 95% CI 1.45 to 1.67) (p<0.001) was related to increased delay. The occurrence of MACE in the first year of follow-up was related to different risk factors, along with a delay in healthcare (HR 1.25, 95% CI 1.10 to 1.54) (p<0.042).
Conclusion:
This study shows that young patients with STEMI tend to receive a sooner diagnosis than older individuals. Delays in healthcare represent one of the main factors related to the occurrence of MACE and non-event-free survival.
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