Master of Public Health Program, Vanderbilt University School of Medicine, Nashville, Tennessee.
Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
J Emerg Med. 2021 Jun;60(6):716-728. doi: 10.1016/j.jemermed.2021.01.031. Epub 2021 Mar 3.
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.
ST 段抬高型心肌梗死（STEMI）主要影响老年人。年轻患者的发病率较低可能会对诊断构成挑战。
我们假设，在≤50 岁的患者中，与年龄>50 岁的患者相比，STEMI 的紧急经皮冠状动脉介入治疗（PCI）会延迟。
这是一项为期 3 年、涉及 10 个中心的回顾性队列研究，纳入了接受紧急 PCI 治疗的≥18 岁急诊 STEMI 患者。我们排除了心电图（ECG）在到达急诊前完成或初始 ECG 无诊断意义的患者。我们的主要结局是门球时间（D2B 时间）。我们比较了年轻 STEMI 患者与老年 STEMI 患者之间以及不同年龄亚组之间的特征和结局。
共有 576 例 ED STEMI PCI 患者，其中 100 例≤50 岁，476 例>50 岁。年轻组的中位年龄为 44 岁（四分位距 [IQR] 41-47），老年组为 62 岁（IQR 57-70）。年轻组的中位 D2B 时间为 76.5 分钟（IQR 67.5-102.5），老年组为 81.0 分钟（IQR 65.0-105.5）（p=0.91）。当使用 40 岁或 45 岁来划定年轻与老年时，这一结果并未改变。年轻组的非白种人比例（38%比 21%；p<0.001）和当前吸烟者比例（36%比 23%；p=0.005）更高。非常年轻（≤30 岁；576 例中有 6 例）和非常年老（>80 岁；576 例中有 45 例）发生 D2B 时间延长的可能性分别为 5.51 倍和 2.2 倍。
我们没有发现≤50 岁与>50 岁患者之间 D2B 时间存在统计学显著差异。非白种人和吸烟者在年轻人群中所占比例不成比例。非常年轻和非常年老的患者 D2B 时间>90 分钟的可能性更高。
