Age and Gender Differences in Quality of Care and Outcomes for Patients with ST-segment Elevation Myocardial Infarction - 20/09/12
, Gregg C. Fonarow, MD b, Eric D. Peterson, MD, MPH c, Anne S. Hellkamp, MS c, Adrian F. Hernandez, MD c, Warren Laskey, MD d, W. Frank Peacock, MD e, Christopher P. Cannon, MD f, Lee H. Schwamm, MD g, Deepak L. Bhatt, MD, MPH hGet with the Guidelines Steering Committee and Investigators
Requests for reprints should be addressed to Sripal Bangalore, MD, MHA, Director of Research, Cardiac Catheterization Laboratory, The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY 10016Abstract |
Background |
Young patients (aged≤45 years) presenting with ST-segment elevation myocardial infarction present unique challenges. The quality of care and in-hospital outcomes may differ from their older counterparts.
Methods |
A total of 31,544 patients presenting with ST-segment elevation myocardial infarction and enrolled in the American Heart Association's Get With the Guidelines Coronary Artery Disease registry were analyzed. The cohort was divided into those aged 45 years or less and those aged more than 45 years.
Results |
Young patients accounted for 10.3% of all ST-segment elevation myocardial infarction cases. Compared with older patients, younger patients were less likely to have traditional cardiovascular risk factors and had similar or better quality/performance measures with lower in-hospital mortality (unadjusted rate 1.6 vs 6.5%, P<.0001; adjusted odds ratio [OR], 0.37; 95% confidence interval [CI], 0.29-0.46). Time trend analysis (2002-2008) suggested an increase over time in the “all or none” composite performance measure in both the younger and older patients (68%-97% and 69%-96%, respectively). However, there was significantly lower quality of care and worse outcomes in women (vs men) and in the very young (≤35 vs 36-45 years). Significant interaction was seen between age and gender for in-hospital death, such that the gender difference was greater in the younger cohort. Similar interaction was seen for door-to-thrombolytic time such that the gender delay was greater in the younger cohort (women:men ratio of means=1.73, 95% CI, 1.21-2.45 [younger] vs 1.08, 95% CI, 1.00-1.18 [older]; Pinteraction=.0031).
Conclusion |
Young patients aged 45 years or less presenting with ST-segment elevation myocardial infarction overall had similar quality of care and in-hospital outcomes as older counterparts. However, quality of care was significantly lower and mortality was higher in young women (vs young men) and the very young (≤35 vs 36-45 years).
Le texte complet de cet article est disponible en PDF.Keywords : Gender, Myocardial infarction, Prognosis, Young
Plan
| Funding: The Get With The Guidelines-Coronary Artery Disease (GWTG-CAD) program was provided by the American Heart Association. The GWTG-CAD program was supported in part through the American Heart Association Pharmaceutical Roundtable and an unrestricted educational grant from Merck. |
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| Conflicts of Interest: Sripal Bangalore: advisory board for Daichii Sankyo. Gregg C. Fonarow: consulting for Novartis Pfizer. Eric Peterson: research funding from BMS/Sanofi, Eli Lilly, Merck, and Ortho McNeil Pharmaceuticals. Anne S. Hellkamp: none. Adrian F. Hernandez: none. Warren Laskey: none. Frank Peacock: scientific advisory board for Abbott, Beckman-Coulter, Biosite, and The Medicines Co; research grants for Abbott, BAS, Biosite, Brahms, Nanosphere, EKR, and The Medicines Co; speakers bureau for Abbott, Biosite, and The Medicines Co; ownership interest in Vital Sensors. Christopher P. Cannon: research grants/support from Accumetrics, AstraZeneca, Glaxo Smith Kline, Merck, and Takeda; advisory board (but funds donated to charity) for Bristol-Myers Squibb/Sanofi, Novartis, and Alnylam; honorarium for development of independent educational symposia for Pfizer and AstraZeneca; clinical advisor for and equity in Automedics Medical Systems. Lee Schwamm: Chair, GWTG steering committee (unpaid). Deepak L. Bhatt: research grants from Astra Zeneca, Bristol-Myers Squibb, Eisai, Ethicon, Medtronic, Sanofi Aventis, The Medicines Company, and Amarin. |
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| Authorship: All authors had access to the data and played a role in writing this manuscript. |
Vol 125 - N° 10
P. 1000-1009 - octobre 2012 Retour au numéro
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