Temporal trends and sex differences in revascularization and outcomes of ST-segment elevation myocardial infarction in younger adults in the United States

Sahil Khera, Dhaval Kolte, Tanush Gupta, Kathir Selvan Subramanian, Neel Khanna, Wilbert S. Aronow, Chul Ahn, Robert J. Timmermans, Howard A. Cooper, Gregg C. Fonarow, William H. Frishman, Julio A. Panza, Deepak L. Bhatt

Research output: Contribution to journalArticlepeer-review

106 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1961-1972
Number of pages12
JournalJournal of the American College of Cardiology
Volume66
Issue number18
DOIs
StatePublished - Nov 3 2015

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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