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J Am Coll Cardiol. 2015 Nov 3;66(18):1961-72. doi: 10.1016/j.jacc.2015.08.865.

Temporal Trends and Sex Differences in Revascularization and Outcomes of ST-Segment Elevation Myocardial Infarction in Younger Adults in the United States.

Author information

  • 1Department of Medicine, Division of Cardiology, New York Medical College, Valhalla, New York.
  • 2Departments of Clinical Sciences and Biostatistics, University of Texas Southwestern Medical Center, Dallas, Texas.
  • 3Division of Cardiology, University of California at Los Angeles, Los Angeles, California.
  • 4Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts. Electronic address: dlbhattmd@post.harvard.edu.

Abstract

BACKGROUND:

Older women presenting with ST-segment elevation myocardial infarction (STEMI) are less likely to receive revascularization and have worse outcomes relative to their male counterparts.

OBJECTIVES:

This study sought to determine temporal trends and sex differences in revascularization and in-hospital outcomes of younger patients with STEMI.

METHODS:

We used the 2004 to 2011 Nationwide Inpatient Sample databases to identify all patients age 18 to 59 years hospitalized with STEMI. Temporal trends and sex differences in revascularization strategies, in-hospital mortality, and length of stay were analyzed.

RESULTS:

From 2004 to 2011, of 1,363,492 younger adults (age <60 years) with acute myocardial infarction, 632,930 (46.4%) had STEMI. Younger women with acute myocardial infarction were less likely than men to present with STEMI (adjusted odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.73 to 0.75). Younger women with STEMI were less likely to receive reperfusion as compared with younger men (percutaneous coronary intervention adjusted OR: 0.74; 95% CI: 0.73 to 0.75) (coronary artery bypass grafting adjusted OR: 0.61; 95% CI: 0.60 to 0.62) (thrombolysis adjusted OR: 0.80; 95% CI: 0.78 to 0.82). From 2004 to 2011, use of percutaneous coronary intervention for STEMI increased in both younger men (63.9% to 84.8%; ptrend < 0.001) and women (53.6% to 77.7%; ptrend < 0.001). In-hospital mortality was significantly higher in younger women compared with men (4.5% vs. 3.0%; adjusted OR: 1.11; 95% CI: 1.07 to 1.15). There was an increasing trend in risk-adjusted in-hospital mortality in both younger men and women during the study period. Length of stay decreased in both younger men and women (ptrend < 0.001).

CONCLUSIONS:

Younger women are less likely to receive revascularization for STEMI and have higher in-hospital mortality as compared with younger men. Use of percutaneous coronary intervention for STEMI and in-hospital mortality have increased, whereas length of stay has decreased in both sexes over the past several years.

Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

ST-segment elevation myocardial infarction; in-hospital mortality; revascularization; sex differences

PMID:
26515998
[PubMed - indexed for MEDLINE]
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