Comparison of delay times between Symptom onset of an acute ST-elevation myocardial infarction and hospital arrival in men and women <65 years versus ≥65 years of age: Findings from the multicenter Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study

Karl-Heinz Ladwig, Xiaoyan Fang, Kathrin Wolf, Sophia Hoschar, Loai Albarqouni, Joram Ronel, Thomas Meinertz, Derek Spieler, Karl-Ludwig Laugwitz, Heribert Schunkert

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8 Citations (Scopus)

Abstract

Early administration of reperfusion therapy in acute ST-elevation myocardial infarctions (STEMI) is crucial to reduce mortality. Although female sex and old age are key factors contributing to an inadequate long prehospital delay time, little is known whether women ≥65 years are a particular risk population. Hence, we studied the interaction of sex and age (<65 years or ≥65 years) and the contribution of chest pain to delay time during STEMI. Bedside interview data were collected in 619 STEMI patients from the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Sex and age group stratification disclosed an excess delay risk for women ≥65 years, accounting for a 2.39 (95% confidence interval (CI) 1.39 to 4.10)-fold higher odds to delay longer than 2 hours compared with all other patient groups including younger women (p ≤0.002). Median delay time was 266 minutes in women ≥65 years and 148 minutes in younger women (p <0.001). Chest pain during STEMI had the lowest frequency both in women (81%) and men ≥65 years (83%) and the highest frequency (95%) in younger women. Experiencing non-chest pain was 2.32-fold (95% CI, 1.20 to 4.46, p <0.05) higher in women ≥65 years than in all other patients. Mediation analysis disclosed that the effect accounted for only 9% of the variance. Age specific educational strategies targeting women ≥65 years at risk are urgently needed. To tailor adequate strategies, more research is required to understand age- and sex driven barriers to timely identification of ischemic symptoms.

Original languageEnglish
Pages (from-to)2128-2134
Number of pages7
JournalTransactions. American College of Cardiology
Volume120
Issue number12
Early online date18 Sep 2017
DOIs
Publication statusPublished - 15 Dec 2017
Externally publishedYes

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Myocardial Infarction
Chest Pain
Confidence Intervals
ST Elevation Myocardial Infarction
Age Factors
Reperfusion
Age Groups
Interviews
Pain
Mortality
Research
Population

Cite this

@article{4b9a3f93028e4baeaaa7cf4c143e71b5,
title = "Comparison of delay times between Symptom onset of an acute ST-elevation myocardial infarction and hospital arrival in men and women <65 years versus ≥65 years of age: Findings from the multicenter Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study",
abstract = "Early administration of reperfusion therapy in acute ST-elevation myocardial infarctions (STEMI) is crucial to reduce mortality. Although female sex and old age are key factors contributing to an inadequate long prehospital delay time, little is known whether women ≥65 years are a particular risk population. Hence, we studied the interaction of sex and age (<65 years or ≥65 years) and the contribution of chest pain to delay time during STEMI. Bedside interview data were collected in 619 STEMI patients from the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Sex and age group stratification disclosed an excess delay risk for women ≥65 years, accounting for a 2.39 (95{\%} confidence interval (CI) 1.39 to 4.10)-fold higher odds to delay longer than 2 hours compared with all other patient groups including younger women (p ≤0.002). Median delay time was 266 minutes in women ≥65 years and 148 minutes in younger women (p <0.001). Chest pain during STEMI had the lowest frequency both in women (81{\%}) and men ≥65 years (83{\%}) and the highest frequency (95{\%}) in younger women. Experiencing non-chest pain was 2.32-fold (95{\%} CI, 1.20 to 4.46, p <0.05) higher in women ≥65 years than in all other patients. Mediation analysis disclosed that the effect accounted for only 9{\%} of the variance. Age specific educational strategies targeting women ≥65 years at risk are urgently needed. To tailor adequate strategies, more research is required to understand age- and sex driven barriers to timely identification of ischemic symptoms.",
author = "Karl-Heinz Ladwig and Xiaoyan Fang and Kathrin Wolf and Sophia Hoschar and Loai Albarqouni and Joram Ronel and Thomas Meinertz and Derek Spieler and Karl-Ludwig Laugwitz and Heribert Schunkert",
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Comparison of delay times between Symptom onset of an acute ST-elevation myocardial infarction and hospital arrival in men and women <65 years versus ≥65 years of age : Findings from the multicenter Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. / Ladwig, Karl-Heinz; Fang, Xiaoyan; Wolf, Kathrin; Hoschar, Sophia; Albarqouni, Loai; Ronel, Joram; Meinertz, Thomas; Spieler, Derek; Laugwitz, Karl-Ludwig; Schunkert, Heribert.

In: Transactions. American College of Cardiology, Vol. 120, No. 12, 15.12.2017, p. 2128-2134.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Comparison of delay times between Symptom onset of an acute ST-elevation myocardial infarction and hospital arrival in men and women <65 years versus ≥65 years of age

T2 - Findings from the multicenter Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study

AU - Ladwig, Karl-Heinz

AU - Fang, Xiaoyan

AU - Wolf, Kathrin

AU - Hoschar, Sophia

AU - Albarqouni, Loai

AU - Ronel, Joram

AU - Meinertz, Thomas

AU - Spieler, Derek

AU - Laugwitz, Karl-Ludwig

AU - Schunkert, Heribert

N1 - Copyright © 2017 Elsevier Inc. All rights reserved.

PY - 2017/12/15

Y1 - 2017/12/15

N2 - Early administration of reperfusion therapy in acute ST-elevation myocardial infarctions (STEMI) is crucial to reduce mortality. Although female sex and old age are key factors contributing to an inadequate long prehospital delay time, little is known whether women ≥65 years are a particular risk population. Hence, we studied the interaction of sex and age (<65 years or ≥65 years) and the contribution of chest pain to delay time during STEMI. Bedside interview data were collected in 619 STEMI patients from the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Sex and age group stratification disclosed an excess delay risk for women ≥65 years, accounting for a 2.39 (95% confidence interval (CI) 1.39 to 4.10)-fold higher odds to delay longer than 2 hours compared with all other patient groups including younger women (p ≤0.002). Median delay time was 266 minutes in women ≥65 years and 148 minutes in younger women (p <0.001). Chest pain during STEMI had the lowest frequency both in women (81%) and men ≥65 years (83%) and the highest frequency (95%) in younger women. Experiencing non-chest pain was 2.32-fold (95% CI, 1.20 to 4.46, p <0.05) higher in women ≥65 years than in all other patients. Mediation analysis disclosed that the effect accounted for only 9% of the variance. Age specific educational strategies targeting women ≥65 years at risk are urgently needed. To tailor adequate strategies, more research is required to understand age- and sex driven barriers to timely identification of ischemic symptoms.

AB - Early administration of reperfusion therapy in acute ST-elevation myocardial infarctions (STEMI) is crucial to reduce mortality. Although female sex and old age are key factors contributing to an inadequate long prehospital delay time, little is known whether women ≥65 years are a particular risk population. Hence, we studied the interaction of sex and age (<65 years or ≥65 years) and the contribution of chest pain to delay time during STEMI. Bedside interview data were collected in 619 STEMI patients from the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Sex and age group stratification disclosed an excess delay risk for women ≥65 years, accounting for a 2.39 (95% confidence interval (CI) 1.39 to 4.10)-fold higher odds to delay longer than 2 hours compared with all other patient groups including younger women (p ≤0.002). Median delay time was 266 minutes in women ≥65 years and 148 minutes in younger women (p <0.001). Chest pain during STEMI had the lowest frequency both in women (81%) and men ≥65 years (83%) and the highest frequency (95%) in younger women. Experiencing non-chest pain was 2.32-fold (95% CI, 1.20 to 4.46, p <0.05) higher in women ≥65 years than in all other patients. Mediation analysis disclosed that the effect accounted for only 9% of the variance. Age specific educational strategies targeting women ≥65 years at risk are urgently needed. To tailor adequate strategies, more research is required to understand age- and sex driven barriers to timely identification of ischemic symptoms.

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U2 - 10.1016/j.amjcard.2017.09.005

DO - 10.1016/j.amjcard.2017.09.005

M3 - Article

VL - 120

SP - 2128

EP - 2134

JO - Transactions. American College of Cardiology

JF - Transactions. American College of Cardiology

SN - 0002-9149

IS - 12

ER -