Sex Differences in Reperfusion in Young Patients With ST-Segment–Elevation Myocardial Infarction: Results From the VIRGO Study
BACKGROUND—Sex disparities in reperfusion therapy for patients with acute ST-segment–elevation myocardial infarction have been documented. However, little is known about whether these patterns exist in the comparison of young women with men. METHODS AND RESULTS—We examined sex differences in rates,...
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Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2015-04, Vol.131 (15), p.1324-1332 |
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creator | D’Onofrio, Gail Safdar, Basmah Lichtman, Judith H Strait, Kelly M Dreyer, Rachel P Geda, Mary Spertus, John A Krumholz, Harlan M |
description | BACKGROUND—Sex disparities in reperfusion therapy for patients with acute ST-segment–elevation myocardial infarction have been documented. However, little is known about whether these patterns exist in the comparison of young women with men.
METHODS AND RESULTS—We examined sex differences in rates, types of reperfusion therapy, and proportion of patients exceeding American Heart Association reperfusion time guidelines for ST-segment–elevation myocardial infarction in a prospective observational cohort study (2008–2012) of 1465 patients 18 to 55 years of age, as part of the US Variations in RecoveryRole of Gender on Outcomes of Young AMI Patients (VIRGO) study at 103 hospitals enrolling in a 2:1 ratio of women to men. Of the 1238 patients eligible for reperfusion, women were more likely to be untreated than men (9% versus 4%, P=0.002). There was no difference in reperfusion strategy for the 695 women and 458 men treated. Women were more likely to exceed in-hospital and transfer time guidelines for percutaneous coronary intervention than men (41% versus 29%; odds ratio, 1.65; 95% confidence interval, 1.27–2.16), more so when transferred (67% versus 44%; odds ratio, 2.63; 95% confidence interval, 1.17–4.07); and more likely to exceed door-to-needle times (67% versus 37%; odds ratio, 2.62; 95% confidence interval, 1.23–2.18). After adjustment for sociodemographic, clinical, and organizational factors, sex remained an important factor in exceeding reperfusion guidelines (odds ratio, 1.72; 95% confidence interval, 1.28–2.33).
CONCLUSIONS—Young women with ST-segment–elevation myocardial infarction are less likely to receive reperfusion therapy and more likely to have reperfusion delays than similarly aged men. Sex disparities are more pronounced among patients transferred to percutaneous coronary intervention institutions or who received fibrinolytic therapy. |
doi_str_mv | 10.1161/CIRCULATIONAHA.114.012293 |
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METHODS AND RESULTS—We examined sex differences in rates, types of reperfusion therapy, and proportion of patients exceeding American Heart Association reperfusion time guidelines for ST-segment–elevation myocardial infarction in a prospective observational cohort study (2008–2012) of 1465 patients 18 to 55 years of age, as part of the US Variations in RecoveryRole of Gender on Outcomes of Young AMI Patients (VIRGO) study at 103 hospitals enrolling in a 2:1 ratio of women to men. Of the 1238 patients eligible for reperfusion, women were more likely to be untreated than men (9% versus 4%, P=0.002). There was no difference in reperfusion strategy for the 695 women and 458 men treated. Women were more likely to exceed in-hospital and transfer time guidelines for percutaneous coronary intervention than men (41% versus 29%; odds ratio, 1.65; 95% confidence interval, 1.27–2.16), more so when transferred (67% versus 44%; odds ratio, 2.63; 95% confidence interval, 1.17–4.07); and more likely to exceed door-to-needle times (67% versus 37%; odds ratio, 2.62; 95% confidence interval, 1.23–2.18). After adjustment for sociodemographic, clinical, and organizational factors, sex remained an important factor in exceeding reperfusion guidelines (odds ratio, 1.72; 95% confidence interval, 1.28–2.33).
CONCLUSIONS—Young women with ST-segment–elevation myocardial infarction are less likely to receive reperfusion therapy and more likely to have reperfusion delays than similarly aged men. Sex disparities are more pronounced among patients transferred to percutaneous coronary intervention institutions or who received fibrinolytic therapy.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.114.012293</identifier><identifier>PMID: 25792558</identifier><language>eng</language><publisher>United States: by the American College of Cardiology Foundation and the American Heart Association, Inc</publisher><subject>Adult ; Cohort Studies ; Electrocardiography ; Female ; Fibrinolytic Agents - therapeutic use ; Humans ; Male ; Middle Aged ; Myocardial Infarction - mortality ; Myocardial Infarction - physiopathology ; Myocardial Infarction - therapy ; Myocardial Reperfusion - methods ; Percutaneous Coronary Intervention ; Prospective Studies ; Quality of Health Care ; Recovery of Function - physiology ; Sex Factors ; Survival Rate ; Time Factors ; Treatment Outcome</subject><ispartof>Circulation (New York, N.Y.), 2015-04, Vol.131 (15), p.1324-1332</ispartof><rights>2015 by the American College of Cardiology Foundation and the American Heart Association, Inc.</rights><rights>2015 American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3615-f36019d683af678e8461d51f5a2761bdc0c77e4e416ae52e310b4fa4c421cf703</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,3687,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25792558$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>D’Onofrio, Gail</creatorcontrib><creatorcontrib>Safdar, Basmah</creatorcontrib><creatorcontrib>Lichtman, Judith H</creatorcontrib><creatorcontrib>Strait, Kelly M</creatorcontrib><creatorcontrib>Dreyer, Rachel P</creatorcontrib><creatorcontrib>Geda, Mary</creatorcontrib><creatorcontrib>Spertus, John A</creatorcontrib><creatorcontrib>Krumholz, Harlan M</creatorcontrib><title>Sex Differences in Reperfusion in Young Patients With ST-Segment–Elevation Myocardial Infarction: Results From the VIRGO Study</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>BACKGROUND—Sex disparities in reperfusion therapy for patients with acute ST-segment–elevation myocardial infarction have been documented. However, little is known about whether these patterns exist in the comparison of young women with men.
METHODS AND RESULTS—We examined sex differences in rates, types of reperfusion therapy, and proportion of patients exceeding American Heart Association reperfusion time guidelines for ST-segment–elevation myocardial infarction in a prospective observational cohort study (2008–2012) of 1465 patients 18 to 55 years of age, as part of the US Variations in RecoveryRole of Gender on Outcomes of Young AMI Patients (VIRGO) study at 103 hospitals enrolling in a 2:1 ratio of women to men. Of the 1238 patients eligible for reperfusion, women were more likely to be untreated than men (9% versus 4%, P=0.002). There was no difference in reperfusion strategy for the 695 women and 458 men treated. Women were more likely to exceed in-hospital and transfer time guidelines for percutaneous coronary intervention than men (41% versus 29%; odds ratio, 1.65; 95% confidence interval, 1.27–2.16), more so when transferred (67% versus 44%; odds ratio, 2.63; 95% confidence interval, 1.17–4.07); and more likely to exceed door-to-needle times (67% versus 37%; odds ratio, 2.62; 95% confidence interval, 1.23–2.18). After adjustment for sociodemographic, clinical, and organizational factors, sex remained an important factor in exceeding reperfusion guidelines (odds ratio, 1.72; 95% confidence interval, 1.28–2.33).
CONCLUSIONS—Young women with ST-segment–elevation myocardial infarction are less likely to receive reperfusion therapy and more likely to have reperfusion delays than similarly aged men. Sex disparities are more pronounced among patients transferred to percutaneous coronary intervention institutions or who received fibrinolytic therapy.</description><subject>Adult</subject><subject>Cohort Studies</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Myocardial Infarction - therapy</subject><subject>Myocardial Reperfusion - methods</subject><subject>Percutaneous Coronary Intervention</subject><subject>Prospective Studies</subject><subject>Quality of Health Care</subject><subject>Recovery of Function - physiology</subject><subject>Sex Factors</subject><subject>Survival Rate</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkc1u00AUhS0EoqHwCsjs2Lid_7FZIEXpn6VAUJKCWI0m4zuJwfaEGbttdn0H3pAnYaKUiq5G99zvnLnSSZJ3GJ1gLPDppJxPrqfjZTn7PL4aR42dIExIQZ8lI8wJyxinxfNkhBAqMkkJOUpehfAjjoJK_jI5IlwWhPN8lNwv4C49q60FD52BkNZdOocteDuE2nX78bsbunX6Rfc1dH1Iv9X9Jl0sswWs2yj8uf993sBN3Eb6084Z7ataN2nZWe3NXv0QA8PQROuFd23abyD9Ws4vZ-miH6rd6-SF1U2ANw_vcXJ9cb6cXGXT2WU5GU8zQwXmmaUC4aISOdVWyBxyJnDFseWaSIFXlUFGSmDAsNDACVCMVsxqZhjBxkpEj5OPh9ztsGqhMvF0rxu19XWr_U45Xaunm67eqLW7UUxwIvMiBrx_CPDu1wChV20dDDSN7sANQWEhKZWRlhEtDqjxLgQP9vEbjNS-QfW0wagxdWgwet_-f-ej819lEWAH4NY1PfjwsxluwasN6KbfqNgxogjLjCDMEcMMZXuJ07-aHat-</recordid><startdate>20150414</startdate><enddate>20150414</enddate><creator>D’Onofrio, Gail</creator><creator>Safdar, Basmah</creator><creator>Lichtman, Judith H</creator><creator>Strait, Kelly M</creator><creator>Dreyer, Rachel P</creator><creator>Geda, Mary</creator><creator>Spertus, John A</creator><creator>Krumholz, Harlan M</creator><general>by the American College of Cardiology Foundation and the American Heart Association, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20150414</creationdate><title>Sex Differences in Reperfusion in Young Patients With ST-Segment–Elevation Myocardial Infarction: Results From the VIRGO Study</title><author>D’Onofrio, Gail ; Safdar, Basmah ; Lichtman, Judith H ; Strait, Kelly M ; Dreyer, Rachel P ; Geda, Mary ; Spertus, John A ; Krumholz, Harlan M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3615-f36019d683af678e8461d51f5a2761bdc0c77e4e416ae52e310b4fa4c421cf703</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Cohort Studies</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocardial Infarction - physiopathology</topic><topic>Myocardial Infarction - therapy</topic><topic>Myocardial Reperfusion - methods</topic><topic>Percutaneous Coronary Intervention</topic><topic>Prospective Studies</topic><topic>Quality of Health Care</topic><topic>Recovery of Function - physiology</topic><topic>Sex Factors</topic><topic>Survival Rate</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>D’Onofrio, Gail</creatorcontrib><creatorcontrib>Safdar, Basmah</creatorcontrib><creatorcontrib>Lichtman, Judith H</creatorcontrib><creatorcontrib>Strait, Kelly M</creatorcontrib><creatorcontrib>Dreyer, Rachel P</creatorcontrib><creatorcontrib>Geda, Mary</creatorcontrib><creatorcontrib>Spertus, John A</creatorcontrib><creatorcontrib>Krumholz, Harlan M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>D’Onofrio, Gail</au><au>Safdar, Basmah</au><au>Lichtman, Judith H</au><au>Strait, Kelly M</au><au>Dreyer, Rachel P</au><au>Geda, Mary</au><au>Spertus, John A</au><au>Krumholz, Harlan M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sex Differences in Reperfusion in Young Patients With ST-Segment–Elevation Myocardial Infarction: Results From the VIRGO Study</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2015-04-14</date><risdate>2015</risdate><volume>131</volume><issue>15</issue><spage>1324</spage><epage>1332</epage><pages>1324-1332</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><abstract>BACKGROUND—Sex disparities in reperfusion therapy for patients with acute ST-segment–elevation myocardial infarction have been documented. However, little is known about whether these patterns exist in the comparison of young women with men.
METHODS AND RESULTS—We examined sex differences in rates, types of reperfusion therapy, and proportion of patients exceeding American Heart Association reperfusion time guidelines for ST-segment–elevation myocardial infarction in a prospective observational cohort study (2008–2012) of 1465 patients 18 to 55 years of age, as part of the US Variations in RecoveryRole of Gender on Outcomes of Young AMI Patients (VIRGO) study at 103 hospitals enrolling in a 2:1 ratio of women to men. Of the 1238 patients eligible for reperfusion, women were more likely to be untreated than men (9% versus 4%, P=0.002). There was no difference in reperfusion strategy for the 695 women and 458 men treated. Women were more likely to exceed in-hospital and transfer time guidelines for percutaneous coronary intervention than men (41% versus 29%; odds ratio, 1.65; 95% confidence interval, 1.27–2.16), more so when transferred (67% versus 44%; odds ratio, 2.63; 95% confidence interval, 1.17–4.07); and more likely to exceed door-to-needle times (67% versus 37%; odds ratio, 2.62; 95% confidence interval, 1.23–2.18). After adjustment for sociodemographic, clinical, and organizational factors, sex remained an important factor in exceeding reperfusion guidelines (odds ratio, 1.72; 95% confidence interval, 1.28–2.33).
CONCLUSIONS—Young women with ST-segment–elevation myocardial infarction are less likely to receive reperfusion therapy and more likely to have reperfusion delays than similarly aged men. Sex disparities are more pronounced among patients transferred to percutaneous coronary intervention institutions or who received fibrinolytic therapy.</abstract><cop>United States</cop><pub>by the American College of Cardiology Foundation and the American Heart Association, Inc</pub><pmid>25792558</pmid><doi>10.1161/CIRCULATIONAHA.114.012293</doi><tpages>9</tpages></addata></record> |
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subjects | Adult Cohort Studies Electrocardiography Female Fibrinolytic Agents - therapeutic use Humans Male Middle Aged Myocardial Infarction - mortality Myocardial Infarction - physiopathology Myocardial Infarction - therapy Myocardial Reperfusion - methods Percutaneous Coronary Intervention Prospective Studies Quality of Health Care Recovery of Function - physiology Sex Factors Survival Rate Time Factors Treatment Outcome |
title | Sex Differences in Reperfusion in Young Patients With ST-Segment–Elevation Myocardial Infarction: Results From the VIRGO Study |
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