Sex Differences in Timeliness of Reperfusion in Young Patients With ST‐Segment–Elevation Myocardial Infarction by Initial Electrocardiographic Characteristics
BackgroundYoung women with ST‐segment–elevation myocardial infarction experience reperfusion delays more frequently than men. Our aim was to determine the electrocardiographic correlates of delay in reperfusion in young patients with ST‐segment–elevation myocardial infarction. Methods and ResultsWe...
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-03-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.117.007021 |
| _version_ | 1828313715328417792 |
|---|---|
| author | Aakriti Gupta Jose A. Barrabes Kelly Strait Hector Bueno Andreu Porta‐Sánchez J. Gabriel Acosta‐Vélez Rosa‐Maria Lidón Erica Spatz Mary Geda Rachel P. Dreyer Nancy Lorenze Judith Lichtman Gail D'Onofrio Harlan M. Krumholz |
| author_facet | Aakriti Gupta Jose A. Barrabes Kelly Strait Hector Bueno Andreu Porta‐Sánchez J. Gabriel Acosta‐Vélez Rosa‐Maria Lidón Erica Spatz Mary Geda Rachel P. Dreyer Nancy Lorenze Judith Lichtman Gail D'Onofrio Harlan M. Krumholz |
| author_sort | Aakriti Gupta |
| collection | DOAJ |
| description | BackgroundYoung women with ST‐segment–elevation myocardial infarction experience reperfusion delays more frequently than men. Our aim was to determine the electrocardiographic correlates of delay in reperfusion in young patients with ST‐segment–elevation myocardial infarction. Methods and ResultsWe examined sex differences in initial electrocardiographic characteristics among 1359 patients with ST‐segment–elevation myocardial infarction in a prospective, observational, cohort study (2008–2012) of 3501 patients with acute myocardial infarction, 18 to 55 years of age, as part of the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study at 103 US and 24 Spanish hospitals enrolling in a 2:1 ratio for women/men. We created a multivariable logistic regression model to assess the relationship between reperfusion delay (door‐to‐balloon time >90 or >120 minutes for transfer or door‐to‐needle time >30 minutes) and electrocardiographic characteristics, adjusting for sex, sociodemographic characteristics, and clinical characteristics at presentation. In our study (834 women and 525 men), women were more likely to exceed reperfusion time guidelines than men (42.4% versus 31.5%; P<0.01). In multivariable analyses, female sex persisted as an important factor in exceeding reperfusion guidelines after adjusting for electrocardiographic characteristics (odds ratio, 1.57; 95% CI, 1.15–2.15). Positive voltage criteria for left ventricular hypertrophy and absence of a prehospital ECG were positive predictors of reperfusion delay; and ST elevation in lateral leads was an inverse predictor of reperfusion delay. ConclusionsSex disparities in timeliness to reperfusion in young patients with ST‐segment–elevation myocardial infarction persisted, despite adjusting for initial electrocardiographic characteristics. Left ventricular hypertrophy by voltage criteria and absence of prehospital ECG are strongly positively correlated and ST elevation in lateral leads is negatively correlated with reperfusion delay. |
| first_indexed | 2024-04-13T16:34:04Z |
| format | Article |
| id | doaj.art-6200bc728e2641a9961931a8c50b613d |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T16:34:04Z |
| publishDate | 2018-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-6200bc728e2641a9961931a8c50b613d2022-12-22T02:39:28ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-03-017610.1161/JAHA.117.007021Sex Differences in Timeliness of Reperfusion in Young Patients With ST‐Segment–Elevation Myocardial Infarction by Initial Electrocardiographic CharacteristicsAakriti Gupta0Jose A. Barrabes1Kelly Strait2Hector Bueno3Andreu Porta‐Sánchez4J. Gabriel Acosta‐Vélez5Rosa‐Maria Lidón6Erica Spatz7Mary Geda8Rachel P. Dreyer9Nancy Lorenze10Judith Lichtman11Gail D'Onofrio12Harlan M. Krumholz13Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, CTHospital Universitari Vall d'Hebron, Barcelona, SpainCenter for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, CTHospital Universitario 12 de Octubre Centro Nacional de Investigaciones Cardiovasculares, Madrid, SpainHospital Universitari Vall d'Hebron, Barcelona, SpainHospital Universitari Vall d'Hebron, Barcelona, SpainHospital Universitari Vall d'Hebron, Barcelona, SpainCenter for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, CTCenter for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, CTCenter for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, CTCenter for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, CTCenter for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, CTDepartment of Emergency Medicine, Yale University School of Medicine, New Haven, CTCenter for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, CTBackgroundYoung women with ST‐segment–elevation myocardial infarction experience reperfusion delays more frequently than men. Our aim was to determine the electrocardiographic correlates of delay in reperfusion in young patients with ST‐segment–elevation myocardial infarction. Methods and ResultsWe examined sex differences in initial electrocardiographic characteristics among 1359 patients with ST‐segment–elevation myocardial infarction in a prospective, observational, cohort study (2008–2012) of 3501 patients with acute myocardial infarction, 18 to 55 years of age, as part of the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study at 103 US and 24 Spanish hospitals enrolling in a 2:1 ratio for women/men. We created a multivariable logistic regression model to assess the relationship between reperfusion delay (door‐to‐balloon time >90 or >120 minutes for transfer or door‐to‐needle time >30 minutes) and electrocardiographic characteristics, adjusting for sex, sociodemographic characteristics, and clinical characteristics at presentation. In our study (834 women and 525 men), women were more likely to exceed reperfusion time guidelines than men (42.4% versus 31.5%; P<0.01). In multivariable analyses, female sex persisted as an important factor in exceeding reperfusion guidelines after adjusting for electrocardiographic characteristics (odds ratio, 1.57; 95% CI, 1.15–2.15). Positive voltage criteria for left ventricular hypertrophy and absence of a prehospital ECG were positive predictors of reperfusion delay; and ST elevation in lateral leads was an inverse predictor of reperfusion delay. ConclusionsSex disparities in timeliness to reperfusion in young patients with ST‐segment–elevation myocardial infarction persisted, despite adjusting for initial electrocardiographic characteristics. Left ventricular hypertrophy by voltage criteria and absence of prehospital ECG are strongly positively correlated and ST elevation in lateral leads is negatively correlated with reperfusion delay.https://www.ahajournals.org/doi/10.1161/JAHA.117.007021ECGreperfusion delaysex differencesST‐segment–elevation myocardial infarction |
| spellingShingle | Aakriti Gupta Jose A. Barrabes Kelly Strait Hector Bueno Andreu Porta‐Sánchez J. Gabriel Acosta‐Vélez Rosa‐Maria Lidón Erica Spatz Mary Geda Rachel P. Dreyer Nancy Lorenze Judith Lichtman Gail D'Onofrio Harlan M. Krumholz Sex Differences in Timeliness of Reperfusion in Young Patients With ST‐Segment–Elevation Myocardial Infarction by Initial Electrocardiographic Characteristics Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease ECG reperfusion delay sex differences ST‐segment–elevation myocardial infarction |
| title | Sex Differences in Timeliness of Reperfusion in Young Patients With ST‐Segment–Elevation Myocardial Infarction by Initial Electrocardiographic Characteristics |
| title_full | Sex Differences in Timeliness of Reperfusion in Young Patients With ST‐Segment–Elevation Myocardial Infarction by Initial Electrocardiographic Characteristics |
| title_fullStr | Sex Differences in Timeliness of Reperfusion in Young Patients With ST‐Segment–Elevation Myocardial Infarction by Initial Electrocardiographic Characteristics |
| title_full_unstemmed | Sex Differences in Timeliness of Reperfusion in Young Patients With ST‐Segment–Elevation Myocardial Infarction by Initial Electrocardiographic Characteristics |
| title_short | Sex Differences in Timeliness of Reperfusion in Young Patients With ST‐Segment–Elevation Myocardial Infarction by Initial Electrocardiographic Characteristics |
| title_sort | sex differences in timeliness of reperfusion in young patients with st segment elevation myocardial infarction by initial electrocardiographic characteristics |
| topic | ECG reperfusion delay sex differences ST‐segment–elevation myocardial infarction |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.117.007021 |
| work_keys_str_mv | AT aakritigupta sexdifferencesintimelinessofreperfusioninyoungpatientswithstsegmentelevationmyocardialinfarctionbyinitialelectrocardiographiccharacteristics AT joseabarrabes sexdifferencesintimelinessofreperfusioninyoungpatientswithstsegmentelevationmyocardialinfarctionbyinitialelectrocardiographiccharacteristics AT kellystrait sexdifferencesintimelinessofreperfusioninyoungpatientswithstsegmentelevationmyocardialinfarctionbyinitialelectrocardiographiccharacteristics AT hectorbueno sexdifferencesintimelinessofreperfusioninyoungpatientswithstsegmentelevationmyocardialinfarctionbyinitialelectrocardiographiccharacteristics AT andreuportasanchez sexdifferencesintimelinessofreperfusioninyoungpatientswithstsegmentelevationmyocardialinfarctionbyinitialelectrocardiographiccharacteristics AT jgabrielacostavelez sexdifferencesintimelinessofreperfusioninyoungpatientswithstsegmentelevationmyocardialinfarctionbyinitialelectrocardiographiccharacteristics AT rosamarialidon sexdifferencesintimelinessofreperfusioninyoungpatientswithstsegmentelevationmyocardialinfarctionbyinitialelectrocardiographiccharacteristics AT ericaspatz sexdifferencesintimelinessofreperfusioninyoungpatientswithstsegmentelevationmyocardialinfarctionbyinitialelectrocardiographiccharacteristics AT marygeda sexdifferencesintimelinessofreperfusioninyoungpatientswithstsegmentelevationmyocardialinfarctionbyinitialelectrocardiographiccharacteristics AT rachelpdreyer sexdifferencesintimelinessofreperfusioninyoungpatientswithstsegmentelevationmyocardialinfarctionbyinitialelectrocardiographiccharacteristics AT nancylorenze sexdifferencesintimelinessofreperfusioninyoungpatientswithstsegmentelevationmyocardialinfarctionbyinitialelectrocardiographiccharacteristics AT judithlichtman sexdifferencesintimelinessofreperfusioninyoungpatientswithstsegmentelevationmyocardialinfarctionbyinitialelectrocardiographiccharacteristics AT gaildonofrio sexdifferencesintimelinessofreperfusioninyoungpatientswithstsegmentelevationmyocardialinfarctionbyinitialelectrocardiographiccharacteristics AT harlanmkrumholz sexdifferencesintimelinessofreperfusioninyoungpatientswithstsegmentelevationmyocardialinfarctionbyinitialelectrocardiographiccharacteristics |