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Sex Differences in Timeliness of Reperfusion in Young Patients With ST-Segment-Elevation Myocardial Infarction by Initial Electrocardiographic Characteristics.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2018 Mar 07; Vol. 7 (6). Date of Electronic Publication: 2018 Mar 07. - Publication Year :
- 2018
-
Abstract
- Background: Young women with ST-segment-elevation myocardial infarction experience reperfusion delays more frequently than men. Our aim was to determine the electrocardiographic correlates of delay in reperfusion in young patients with ST-segment-elevation myocardial infarction.<br />Methods and Results: We examined sex differences in initial electrocardiographic characteristics among 1359 patients with ST-segment-elevation myocardial infarction in a prospective, observational, cohort study (2008-2012) of 3501 patients with acute myocardial infarction, 18 to 55 years of age, as part of the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study at 103 US and 24 Spanish hospitals enrolling in a 2:1 ratio for women/men. We created a multivariable logistic regression model to assess the relationship between reperfusion delay (door-to-balloon time >90 or >120 minutes for transfer or door-to-needle time >30 minutes) and electrocardiographic characteristics, adjusting for sex, sociodemographic characteristics, and clinical characteristics at presentation. In our study (834 women and 525 men), women were more likely to exceed reperfusion time guidelines than men (42.4% versus 31.5%; P <0.01). In multivariable analyses, female sex persisted as an important factor in exceeding reperfusion guidelines after adjusting for electrocardiographic characteristics (odds ratio, 1.57; 95% CI, 1.15-2.15). Positive voltage criteria for left ventricular hypertrophy and absence of a prehospital ECG were positive predictors of reperfusion delay; and ST elevation in lateral leads was an inverse predictor of reperfusion delay.<br />Conclusions: Sex disparities in timeliness to reperfusion in young patients with ST-segment-elevation myocardial infarction persisted, despite adjusting for initial electrocardiographic characteristics. Left ventricular hypertrophy by voltage criteria and absence of prehospital ECG are strongly positively correlated and ST elevation in lateral leads is negatively correlated with reperfusion delay.<br /> (© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.)
- Subjects :
- Adolescent
Adult
Age of Onset
Female
Humans
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Risk Assessment
Risk Factors
ST Elevation Myocardial Infarction epidemiology
ST Elevation Myocardial Infarction physiopathology
Sex Factors
Spain epidemiology
Time Factors
Treatment Outcome
United States epidemiology
Young Adult
Electrocardiography
Healthcare Disparities
Myocardial Reperfusion methods
ST Elevation Myocardial Infarction diagnosis
ST Elevation Myocardial Infarction therapy
Time-to-Treatment
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 7
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 29514807
- Full Text :
- https://doi.org/10.1161/JAHA.117.007021