• Sean M Bloos, Karampreet Kaur, Kendrick Lang, Nicholas Gavin, Angela M Mills, Christopher W Baugh, Brian W Patterson, Seth R Podolsky, Gilberto Salazar, Bryn E Mumma, Mary Tanski, Kelsea Hadley, Christianne Roumie, Candace D McNaughton, and YiadomMaame Yaa A BMYABDepartment of Emergency Medicine, Stanford University, Palo Alto, California..
• Master of Public Health Program, Vanderbilt University School of Medicine, Nashville, Tennessee.
• J Emerg Med. 2021 Jun 1; 60 (6): 716-728.

BackgroundST-segment elevation myocardial infarction (STEMI) predominantly affects older adults. Lower incidence among younger patients may challenge diagnosis.ObjectivesWe hypothesize that among patients ≤ 50 years old, emergent percutaneous coronary intervention (PCI) for STEMI is delayed when compared with patients aged > 50 years.MethodsThis 3-year, 10-center retrospective cohort study included emergency department (ED) STEMI patients ≥ 18 years of age treated with emergent PCI. We excluded patients with an electrocardiogram (ECG) completed prior to ED arrival or a nondiagnostic initial ECG. Our primary outcome was door-to-balloon (D2B) time. We compared characteristics and outcomes among younger vs. older STEMI patients, and among age subgroups.ResultsThere were 576 ED STEMI PCI patients, of whom 100 were ≤ 50 years old and 476 were > 50 years old. Median age was 44 years in the younger cohort (interquartile range [IQR] 41-47) vs. 62 years (IQR 57-70) among older patients. Median D2B time for the younger cohort was 76.5 min (IQR 67.5-102.5) vs. 81.0 min (IQR 65.0-105.5) in the older cohort (p = 0.91). This outcome did not change when ages 40 or 45 years were used to demarcate younger vs. older. The younger cohort had a higher prevalence of nonwhite races (38% vs. 21%; p < 0.001) and those currently smoking (36% vs. 23%; p = 0.005). The very young (≤30 years; 6/576) and very old (>80 years; 45/576) had 5.51 and 2.2 greater odds of delays.ConclusionWe found no statistically significant difference in D2B times between patients ≤ 50 years old and those > 50 years old. Nonwhite patients and those who smoke were disproportionately represented within the younger population. The very young and very old had higher odds of D2B times > 90 min.Copyright © 2021 Elsevier Inc. All rights reserved.

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