Abstract 19989: Sex Differences in Timeliness of Reperfusion in Young Patients With STEMI by Initial ECG Characteristics
Introduction: Young women with ST-segment elevation myocardial infarction (STEMI) are more likely to experience reperfusion delay than similarly aged men. Our aim was to determine the initial ECG correlates of delay in reperfusion in young patients with STEMI.
Methods: We examined sex differences in initial ECG characteristics among young patients with STEMI in a prospective observational cohort study (2008-2012) of 3,502 patients 18 – 55 years of age, as part of the Variations in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study at 103 US hospitals and 24 Spain hospitals enrolling in a 2:1 ratio for women to men. We created a multivariable logistic regression model to assess the relationship between initial ECG characteristics and reperfusion delay (door-to-balloon time > 90 min or 120 min in case of transfer; or door-to-needle time > 30 min) adjusting for sex, socio-demographic and clinical characteristics at presentation.
Results: Baseline characteristics of initial ECGs among 834 women and 525 men presenting with STEMI were notable for similar heart rate, incidence of atrial fibrillation, LBBB and RBBB. Young men, however, had significantly greater extent of ST elevation than young women (2-6 mm, 34.1% vs. 30.7%; ≥ 6 mm, 6.1% vs. 1.6%; p<0.0001). Of the 1359 patients with STEMI, women were more likely to exceed reperfusion time guidelines than men (42.4% vs. 31.5%, p<0.0001). Both young women and men with ST elevation ≤ 2mm, and presence of ST elevation in anterior leads were more likely to experience reperfusion delays. In multivariable analyses, significant ECG correlates of delay in reperfusion included presence of ST elevation in anterior precordial leads (OR 2.79, CI 1.12 – 6.90) and lateral precordial leads (OR 4.37, CI 1.32 – 14.4), with inferior leads as reference for both. Female sex persisted as an important factor in exceeding reperfusion guidelines even after adjusting for ECG characteristics (OR 1.69, CI 1.20- 2.37).
Conclusion: Sex disparities in timeliness to reperfusion in young patients with STEMI persisted despite adjusting for initial ECG characteristics. Patients with anterior and lateral STEMI were more likely to experience reperfusion delay compared with inferior STEMI and reasons for this need further exploration.
Author Disclosures: A. Gupta: None. J.A. Barrabes: None. K. Strait: None. H. Bueno: None. E. Spatz: None. M. Geda: None. R. Dreyer: None. N. Lorenze: None. J. Lichtman: None. G. Donofrio: None. H.M. Krumholz: Other Research Support; Significant; Janssen, pharmaceutical company of Johnson & Johnson, Centers of Medicare & Medicaid Services. Consultant/Advisory Board; Significant; United Healthcare.
- © 2016 by American Heart Association, Inc.