478 Disparities in Time to Reperfusion in ST Elevation Myocardial Infarction (STEMI) at Extremes of Age

Abstract

For STEMI patients, reduced door-to-balloon (DTB) time is associated with improved mortality. Few studies have assessed if there are disparities in DTB in extremes of age. We analysed the Westmead STEMI registry April 2004-February 2019. Symptom to Door (STD) was time in minutes from chest pain onset to triage, DTB was triage to first inflation and symptom to reperfusion time (SRT) was chest pain to TIMI-III flow. Patients were divided into very-young (18-30), young (30-50), standard (51-79) and elderly (>80). Medians were compared using Kruskall-Wallis tests with subsequent pairwise comparisons if positive. There were 3712 patients (very young n=19(0.5%), young n=833(22.4%), standard n=2544(68.6%) and elderly n=315(8.6%). Median STD varied; very-young=99mins, young=90, standard=100 and elderly=100, with STD for young significantly less than standard (p=0.001) and elderly (p=0.001). Median DTB also varied; very-young=131, young=119, standard=109 and elderly=114. Very-young, young and elderly all had significantly higher DTB than standard; p=0.040, p<0.001 and p=0.032 respectively. When stratified by year (2004-09, 2009-14 and 2014-19), there were reductions in median DTB. In 2014-19, although standard had achieved median DTB 88mins, young were still 110mins (p=0.001) [Figure1]. Median SRT varied; very young=301, young=215, standard=215 and elderly=242. Very-young had significantly longer SRT than young (p=0.02) and standard (p=0.019) as did elderly (p=0.022 and p=0.009 respectively). We have for the first time demonstrated in a single institution registry that although young STEMI present sooner, reperfusion targets are not being achieved in the young and very young. Disparities exist in reperfusion at both extremes of age.