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

• Published in: The Journal of emergency medicine Vol. 60; no. 6; pp. 716 - 728
• Main Authors: Bloos, Sean M., Kaur, Karampreet, Lang, Kendrick, Gavin, Nicholas, Mills, Angela M., Baugh, Christopher W., Patterson, Brian W., Podolsky, Seth R., Salazar, Gilberto, Mumma, Bryn E., Tanski, Mary, Hadley, Kelsea, Roumie, Christianne, McNaughton, Candace D., Yiadom, Maame Yaa A.B.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2021
• Subjects: age; D2B; door-to-balloon; emergency department; hyperlipidemia; old; smoking; ST-segment elevation myocardial infarction; STEMI; young; hyperlipidemia; D2B; young; old; smoking; STEMI; door-to-balloon; ST-segment elevation myocardial infarction; emergency department; age
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2021.01.031

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