title: Age and gender differences in quality of care and outcomes for patients with ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Young patients (aged≤45 years) presenting with ST-segment elevation myocardial infarction present unique challenges. The quality of care and in-hospital outcomes may differ from their older counterparts.
  
  
  METHODS
  A total of 31,544 patients presenting with ST-segment elevation myocardial infarction and enrolled in the American Heart Association's Get With the Guidelines Coronary Artery Disease registry were analyzed. The cohort was divided into those aged 45 years or less and those aged more than 45 years.
  
  
  RESULTS
  Young patients accounted for 10.3% of all ST-segment elevation myocardial infarction cases. Compared with older patients, younger patients were less likely to have traditional cardiovascular risk factors and had similar or better quality/performance measures with lower in-hospital mortality (unadjusted rate 1.6 vs 6.5%, P<.0001; adjusted odds ratio [OR], 0.37; 95% confidence interval [CI], 0.29-0.46). Time trend analysis (2002-2008) suggested an increase over time in the "all or none" composite performance measure in both the younger and older patients (68%-97% and 69%-96%, respectively). However, there was significantly lower quality of care and worse outcomes in women (vs men) and in the very young (≤35 vs 36-45 years). Significant interaction was seen between age and gender for in-hospital death, such that the gender difference was greater in the younger cohort. Similar interaction was seen for door-to-thrombolytic time such that the gender delay was greater in the younger cohort (women:men ratio of means=1.73, 95% CI, 1.21-2.45 [younger] vs 1.08, 95% CI, 1.00-1.18 [older]; P(interaction)=.0031).
  
  
  CONCLUSIONS
  Young patients aged 45 years or less presenting with ST-segment elevation myocardial infarction overall had similar quality of care and in-hospital outcomes as older counterparts. However, quality of care was significantly lower and mortality was higher in young women (vs young men) and the very young (≤35 vs 36-45 years).
authors: New York University Medical Center, New York, NY 10016, USA. sripal.bangalore@nyumc.org
authors: Sripal
authors: S
authors: Bangalore
authors: Gregg C
authors: GC
authors: Fonarow
authors: Eric D
authors: ED
authors: Peterson
authors: Anne S
authors: AS
authors: Hellkamp
authors: Adrian F
authors: AF
authors: Hernandez
authors: Warren
authors: W
authors: Laskey
authors: W Frank
authors: WF
authors: Peacock
authors: Christopher P
authors: CP
authors: Cannon
authors: Lee H
authors: LH
authors: Schwamm
authors: Deepak L
authors: DL
authors: Bhatt
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D011379:Prognosis; D019984:Quality Indicators, Health Care; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D014481:United States