Comparing the Timeliness of Treatment in Younger vs. Older Patients with ST-Segment Elevation Myocardial Infarction: A Multi-Center Cohort Study.

Abstract

ST-segment elevation myocardial infarction (STEMI) predominantly affects older adults. Lower incidence among younger patients may challenge diagnosis. We hypothesize that among patients ≤ 50years old, emergent percutaneous coronary intervention (PCI) for STEMI is delayed when compared with patients aged>50years. This 3-year, 10-center retrospective cohort study included emergency department (ED) STEMI patients≥18years 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. There were 576 ED STEMI PCI patients, of whom 100 were ≤ 50years old and 476 were > 50years old. Median age was 44years in the younger cohort (interquartile range [IQR] 41-47) vs. 62years (IQR 57-70) among older patients. Median D2B time for the younger cohort was 76.5min (IQR 67.5-102.5) vs. 81.0min (IQR 65.0-105.5) in the older cohort (p=0.91). This outcome did not change when ages 40 or 45years 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 (≤30years; 6/576) and very old (>80years; 45/576) had 5.51 and 2.2 greater odds of delays. We found no statistically significant difference in D2B times between patients≤50years old and those>50years 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 > 90min.