Sex Differences in Reperfusion in Young Patients with ST-Segment Elevation Myocardial Infarction: Results from the VIRGO Study
Background—Sex disparities in reperfusion therapy for patients with acute ST-Segment Elevation Myocardial Infarction (STEMI) have been documented. However, little is known about whether these patterns exist when comparing young women with men.
Methods and Results—We examined sex differences in rates, types of reperfusion therapy and proportion of patients exceeding AHA reperfusion time guidelines for STEMI in a prospective observational cohort study (2008-2012) of 1,465 patients 18 - 55 years of age, as part of the U.S. Variations in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study at 103 hospitals enrolling in a 2:1 ratio of women to men. Of the 1,238 patients eligible for reperfusion, women were more likely to be untreated than men (9% versus 4%, p=0.002). There was no difference in reperfusion strategy for the 695 women and 458 men treated. Women were more likely to exceed in-hospital and transfer time guidelines for PCI than men, (41% versus 29%; OR 1.65, 95% CI 1.27-2.16), more so when transferred (67% versus 44%; OR 2.63, 95% CI 1.17-4.07); and more likely to exceed door-to-needle times (67% versus 37%: OR 2.62, 95% CI 1.23-2.18). After adjustment for socio-demographic, clinical and organizational factors sex remained an important factor in exceeding reperfusion guidelines (OR 1.72, 95% CI 1.28-2.33).
Conclusions—Young women with STEMI are less likely to receive reperfusion therapy, and more likely to have reperfusion delays compared with similarly aged men. Sex disparities are more pronounced among patients transferred to PCI institutions or who received fibrinolytic therapy.
- Received July 14, 2014.
- Revision received January 14, 2015.
- Accepted January 26, 2015.