title: Temporal Trends and Sex Differences in Revascularization and Outcomes of ST-Segment Elevation Myocardial Infarction in Younger Adults in the United States.
abstract: BACKGROUND
  Older women presenting with ST-segment elevation myocardial infarction (STEMI) are less likely to receive revascularization and have worse outcomes relative to their male counterparts.
  
  
  OBJECTIVE
  This study sought to determine temporal trends and sex differences in revascularization and in-hospital outcomes of younger patients with STEMI.
  
  
  METHODS
  We used the 2004 to 2011 Nationwide Inpatient Sample databases to identify all patients age 18 to 59 years hospitalized with STEMI. Temporal trends and sex differences in revascularization strategies, in-hospital mortality, and length of stay were analyzed.
  
  
  RESULTS
  From 2004 to 2011, of 1,363,492 younger adults (age <60 years) with acute myocardial infarction, 632,930 (46.4%) had STEMI. Younger women with acute myocardial infarction were less likely than men to present with STEMI (adjusted odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.73 to 0.75). Younger women with STEMI were less likely to receive reperfusion as compared with younger men (percutaneous coronary intervention adjusted OR: 0.74; 95% CI: 0.73 to 0.75) (coronary artery bypass grafting adjusted OR: 0.61; 95% CI: 0.60 to 0.62) (thrombolysis adjusted OR: 0.80; 95% CI: 0.78 to 0.82). From 2004 to 2011, use of percutaneous coronary intervention for STEMI increased in both younger men (63.9% to 84.8%; ptrend < 0.001) and women (53.6% to 77.7%; ptrend < 0.001). In-hospital mortality was significantly higher in younger women compared with men (4.5% vs. 3.0%; adjusted OR: 1.11; 95% CI: 1.07 to 1.15). There was an increasing trend in risk-adjusted in-hospital mortality in both younger men and women during the study period. Length of stay decreased in both younger men and women (ptrend < 0.001).
  
  
  CONCLUSIONS
  Younger women are less likely to receive revascularization for STEMI and have higher in-hospital mortality as compared with younger men. Use of percutaneous coronary intervention for STEMI and in-hospital mortality have increased, whereas length of stay has decreased in both sexes over the past several years.
authors.affiliation: Department of Medicine, Division of Cardiology, New York Medical College, Valhalla, New York.
authors.forename: Sahil
authors.initials: S
authors.lastname: Khera
authors.affiliation: Department of Medicine, Division of Cardiology, New York Medical College, Valhalla, New York.
authors.forename: Dhaval
authors.initials: D
authors.lastname: Kolte
authors.affiliation: Department of Medicine, Division of Cardiology, New York Medical College, Valhalla, New York.
authors.forename: Tanush
authors.initials: T
authors.lastname: Gupta
authors.affiliation: Department of Medicine, Division of Cardiology, New York Medical College, Valhalla, New York.
authors.forename: Kathir Selvan
authors.initials: KS
authors.lastname: Subramanian
authors.affiliation: Department of Medicine, Division of Cardiology, New York Medical College, Valhalla, New York.
authors.forename: Neel
authors.initials: N
authors.lastname: Khanna
authors.affiliation: Department of Medicine, Division of Cardiology, New York Medical College, Valhalla, New York.
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.affiliation: Departments of Clinical Sciences and Biostatistics, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Chul
authors.initials: C
authors.lastname: Ahn
authors.affiliation: Department of Medicine, Division of Cardiology, New York Medical College, Valhalla, New York.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Timmermans
authors.affiliation: Department of Medicine, Division of Cardiology, New York Medical College, Valhalla, New York.
authors.forename: Howard A
authors.initials: HA
authors.lastname: Cooper
authors.affiliation: Division of Cardiology, University of California at Los Angeles, Los Angeles, California.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Department of Medicine, Division of Cardiology, New York Medical College, Valhalla, New York.
authors.forename: William H
authors.initials: WH
authors.lastname: Frishman
authors.affiliation: Department of Medicine, Division of Cardiology, New York Medical College, Valhalla, New York.
authors.forename: Julio A
authors.initials: JA
authors.lastname: Panza
authors.affiliation: Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts. Electronic address: dlbhattmd@post.harvard.edu.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
mesh_terms: D000328:Adult; D000367:Age Factors; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D009204:Myocardial Revascularization / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
keywords: ST-segment elevation myocardial infarction; in-hospital mortality; revascularization; sex differences