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dc.contributor.authorGupta, Aakriti
dc.contributor.authorBarrabés, José A
dc.contributor.authorStrait, Kelly
dc.contributor.authorBueno, Hector 
dc.contributor.authorPorta-Sanchez, Andreu 
dc.contributor.authorAcosta-Velez, J. Gabriel
dc.contributor.authorLidon, Rosa-Maria
dc.contributor.authorSpatz, Erica
dc.contributor.authorGeda, Mary
dc.contributor.authorDreyer, Rachel P.
dc.contributor.authorLorenze, Nancy
dc.contributor.authorLichtman, Judith
dc.contributor.authorD'Onofrio, Gail
dc.contributor.authorKrumholz, Harlan M.
dc.identifier.citationJ Am Heart Assoc. 2018; 7(6):e007021
dc.description.abstractBackground-Young women with ST-segment-elevation myocardial infarction experience reperfusion delays more frequently than men. Our aim was to determine the electrocardiographic correlates of delay in reperfusion in young patients with ST-segment-elevation myocardial infarction. Methods and Results-We examined sex differences in initial electrocardiographic characteristics among 1359 patients with ST-segment-elevation myocardial infarction in a prospective, observational, cohort study (2008-2012) of 3501 patients with acute myocardial infarction, 18 to 55 years of age, as part of the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study at 103 US and 24 Spanish hospitals enrolling in a 2:1 ratio for women/men. We created a multivariable logistic regression model to assess the relationship between reperfusion delay (door-to-balloon time >90 or >120 minutes for transfer or door-to-needle time >30 minutes) and electrocardiographic characteristics, adjusting for sex, sociodemographic characteristics, and clinical characteristics at presentation. In our study (834 women and 525 men), women were more likely to exceed reperfusion time guidelines than men (42.4\% versus 31.5\%; P<0.01). In multivariable analyses, female sex persisted as an important factor in exceeding reperfusion guidelines after adjusting for electrocardiographic characteristics (odds ratio, 1.57; 95\% CI, 1.15-2.15). Positive voltage criteria for left ventricular hypertrophy and absence of a prehospital ECG were positive predictors of reperfusion delay; and ST elevation in lateral leads was an inverse predictor of reperfusion delay. Conclusions-Sex disparities in timeliness to reperfusion in young patients with ST-segment-elevation myocardial infarction persisted, despite adjusting for initial electrocardiographic characteristics. Left ventricular hypertrophy by voltage criteria and absence of prehospital ECG are strongly positively correlated and ST elevation in lateral leads is negatively correlated with reperfusion delay.
dc.description.sponsorshipThis work was supported by grants from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services (R01 HL081153, F30HL120498 to EMB, and U01 HL105270 to the Center for Cardiovascular Outcomes Research at Yale University). Infarto de miocardio en la Mujer Joven (the Spanish component of VIRGO [Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients]) is supported in Spain by the Fondo de Investigaciones Sanitarias del Instituto Carlos III, Ministry of Science and Technology (PI 081614) and additional funds from the Centro Nacional de Investigaciones Cardiovasculares. Gupta is supported by grant HL007854 from the National Institutes of Health. Spatz is supported by grant K12HS023000 from the Agency for Healthcare Research and Quality Patient-Centered Outcomes Research Institute Mentored Career Development Program.
dc.relation.isversionofPublisher's version
dc.subjectreperfusion delay
dc.subjectsex differences
dc.subjectST-segment-elevation myocardial infarction
dc.titleSex Differences in Timeliness of Reperfusion in Young Patients With ST-Segment-Elevation Myocardial Infarction by Initial Electrocardiographic Characteristics
dc.rights.licenseAttribution-NonCommercial-NoDerivatives 4.0 Internacional*
dc.contributor.funderNational Institutes of Health
dc.contributor.funderFondo de Investigaciones Sanitarias
dc.contributor.funderCentro Nacional de Investigaciones Cardiovasculares
dc.contributor.funderInstituto de Salud Carlos III - ISCIII
dc.contributor.funderMinisterio de Ciencia y Tecnología (España)
dc.identifier.journalJournal of the American Heart Association
dc.repisalud.orgCNICCNIC::Grupos de investigación::Investigación Cardiovascular Traslacional Multidisciplinaria

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Attribution-NonCommercial-NoDerivatives 4.0 Internacional
This item is licensed under a: Attribution-NonCommercial-NoDerivatives 4.0 Internacional