Abstract 12038: Effect of Delays in Treatment on Outcome in Young Women and Men With ST-Elevation Myocardial Infarction: Results From the PRAXY Study
Introduction: Sex differences in outcomes after ACS persist, specifically among younger patients. Delays in treatment have been implicated in explaining worse outcomes in women. The impact of delays and their interaction with sex on outcomes in younger patients with ACS is unknown.
Hypotheses: We assessed whether longer time from “door to-“ ECG (>10 min.), balloon (>90 min.), and needle (>30 min.), would be associated with an increased risk of major adverse cardiovascular events (MACE), 12 months post-ACS, and whether these associations differ by sex.
Methods: This analysis included 469 ST-elevation myocardial infarction (STEMI) patients (≤ 55 years, 25% women) recruited in the GENESIS PRAXY study, from 26 sites in Canada, the US and Switzerland, between January 2009 and September 2012. Baseline treatment and follow-up outcomes data were collected through chart review. MACE included: ACS, stroke, PCI, CABG, and cardiac mortaity. Cox regressions, adjusted for age, were used to assess the impact of delays, sex, and their interaction on outcomes.
Results: The proportions of women and men with time from “door to-“ ECG >10 min., balloon >90 min., and needle >30 min. were: 50% vs. 43%, 68% vs. 56%, and 63% vs. 47%, respectively (p’s>0.05). Cox regressions adjusted for age indicated that times from door-to-ECG >10 minutes were associated with a 2.44-fold increased risk of MACE (95%CI: 1.10-5.47, p=0.03), compared to delays ≤10 minutes. Times from door-to-balloon >90 minutes were also associated with an increased risk of MACE (OR=2.60, 95%CI: 1.14-5.93, p=0.02) during the 12 months post-ACS. Finally, we observed that patients with a delay from door-to-ballon >90 minutes had a 3.75 increased risk of revascularization (95%CI: 1.44-9.75, p≤0.01) during the follow-up period. There was no association between sex and the risk of MACE or revascularization, and no interaction effect between sex and treatment delays.
Conclusion: An important proportion of young women and men with STEMI do not meet the AHA/ACC guidelines regarding times from “door-to” ECG, balloon and needle. These patients are more than twice as likely to experience a MACE during the year following their ACS, irrespective of sex. Reducing delays in treatment among women and men with premature ACS is imperative.
- © 2013 by American Heart Association, Inc.