Sivashanmugathas Varunaavee, El-Baba Mazen, Jones Marcella K, Kiss Alex, Meyers H Pendell, Smith Stephen W, Chartier Lucas B, McLaren Jesse T T
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
CJC Open. 2025 Jan 23;7(5):632-640. doi: 10.1016/j.cjco.2025.01.016. eCollection 2025 May.
Patients with occlusion myocardial infarction (OMI) who meet the ST-elevation myocardial infarction (STEMI) criteria experience inequitable delays in care, because of sociodemographic factors, such as age and sex. OMI patients who do not meet STEMI criteria and are admitted to the hospital as non-STEMI patients, experience further delays. However, whether equity gaps exist in OMI care remains unknown.
A retrospective chart review included patients with acute coronary syndrome admitted to the hospital through 2 academic emergency departments, in the period from January 1, 2021 to December 31, 2022. Patients were categorized as having one of the following: OMI (acute culprit with Thrombolysis In Myocardial Infarction [TIMI] 0-2 flow, or acute culprit with TIMI 3 flow, and a troponin I level > 10,000 ng/L; or if they had no angiogram, a troponin I level > 10,000 ng/L plus new regional wall-motion abnormality on echocardiogram); non-OMI (MI that did not meet the OMI threshold); or MI ruled out.
Among 662 charts, 260 were OMI patients, 296 were non-OMI patients, and 106 were patients with MI ruled out. Of the 260 OMI patients, 116 were admitted to the hospital as STEMI patients (true-positive), and 144 (55.4%) were admitted as non-STEMI patients (false-negative). In bivariate analyses, true-positive STEMI patients with atypical symptoms had a longer door-to-electrocardiogram (ECG) time ( < 0.0001) and a longer ECG-to-catheterization time ( < 0.001). False-negative STEMI patients had a longer door-to-ECG time for atypical symptoms ( < 0.0001), a longer ECG-to-catheterization time for atypical symptoms ( = 0.003), and were aged ≥75 years ( = 0.006).
True-positive STEMI patients had delayed ECGs and catheterization for those presenting with atypical symptoms. More than half of those with OMI were admitted as non-STEMI patients, with further reperfusion delays for older patients and those presenting with atypical symptoms. Shifting to the OMI paradigm highlights reperfusion delays and equity gaps in the management of ACS.
符合ST段抬高型心肌梗死（STEMI）标准的闭塞性心肌梗死（OMI）患者，由于年龄和性别等社会人口统计学因素，在接受治疗时会经历不公平的延迟。不符合STEMI标准并以非STEMI患者身份入院的OMI患者，会经历更长时间的延迟。然而，OMI治疗中是否存在公平性差距仍不清楚。
一项回顾性病历审查纳入了2021年1月1日至2022年12月31日期间通过两个学术急诊科入院的急性冠状动脉综合征患者。患者被分类为以下情况之一：OMI（急性罪犯血管血流为心肌梗死溶栓治疗[TIMI]0 - 2级，或急性罪犯血管血流为TIMI 3级且肌钙蛋白I水平>10000 ng/L；或者如果未进行血管造影，则肌钙蛋白I水平>10000 ng/L且超声心动图显示新的节段性室壁运动异常）；非OMI（不符合OMI阈值的心肌梗死）；或心肌梗死排除。
在662份病历中，260例为OMI患者，296例为非OMI患者，106例为心肌梗死排除患者。在260例OMI患者中，116例以STEMI患者身份入院（真阳性），144例（55.4%）以非STEMI患者身份入院（假阴性）。在二元分析中，有非典型症状的真阳性STEMI患者从就诊到心电图（ECG）的时间更长（<0.0001），从心电图到导管插入术的时间更长（<0.001）。假阴性STEMI患者有非典型症状时从就诊到心电图的时间更长（<0.0001），有非典型症状时从心电图到导管插入术的时间更长（=0.003），且年龄≥75岁（=0.006）。
有非典型症状的真阳性STEMI患者心电图检查和导管插入术延迟。超过一半的OMI患者以非STEMI患者身份入院，老年患者和有非典型症状的患者再灌注延迟进一步加剧。转向OMI模式凸显了急性冠状动脉综合征管理中的再灌注延迟和公平性差距。
