TY - JOUR
T1 - Outcomes of ST-elevation myocardial infarction by age and sex in a low-income urban community
T2 - The Montefiore STEMI Registry
AU - Bortnick, Anna E.
AU - Shahid, Muhammad
AU - Shitole, Sanyog G.
AU - Park, Michael
AU - Broder, Anna
AU - Rodriguez, Carlos J.
AU - Scheuer, James
AU - Faillace, Robert
AU - Kizer, Jorge
N1 - Funding Information:
Funding for the Registry was provided by the Division of Cardiology, Montefiore Health System. The Registry is indebted to Margaret Galvin, RN and Victoria Rosal-Grief, RN, for their data collection efforts. The present work also acknowledges support from the Einstein-Rockefeller-CUNY Center for AIDS Research (P30-AI124414), funded by the following NIH Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, and OAR. Anna E. Bortnick recognizes support from an American Heart Association Mentored and Clinical Population Research Award 17MCPRP33630098 and K23 HL146982 from the National Heart, Lung and Blood Institute (NHLBI). Jorge R. Kizer is supported by a K24 HL135493 from the NHLBI.
Funding Information:
Funding for the Registry was provided by the Division of Cardiology, Montefiore Health System. The Registry is indebted to Margaret Galvin, RN and Victoria Rosal‐Grief, RN, for their data collection efforts. The present work also acknowledges support from the Einstein‐Rockefeller‐CUNY Center for AIDS Research (P30‐AI124414), funded by the following NIH Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, and OAR. Anna E. Bortnick recognizes support from an American Heart Association Mentored and Clinical Population Research Award 17MCPRP33630098 and K23 HL146982 from the National Heart, Lung and Blood Institute (NHLBI). Jorge R. Kizer is supported by a K24 HL135493 from the NHLBI.
Publisher Copyright:
© 2020 The Authors. Clinical Cardiology published by Wiley Periodicals, LLC.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Objectives: To compare outcomes by age and sex in race/ethnic minorities presenting with ST-elevation myocardial infarction (STEMI), as studies are limited. Methods: We studied sociodemographics, management, and outcomes in 1208 STEMI patients evaluated for primary percutaneous coronary intervention between 2008 and 2014 at Montefiore Health System (Bronx, NY). A majority of patients self-identified as nonwhite, and nearly two-thirds were young ('45 years) or middle-aged (45-64 years). Results: Risk factors varied significantly across age groups; with more women and non-Hispanic whites, hypertension, diabetes, dyslipidemia, prior cardiovascular disease, non-sinus rhythm, and collagen vascular disease in the older age group (≥65 years); and higher body mass index, smoking, cocaine use, human immunodeficiency virus (HIV) infection and family history of heart disease in the young. Younger women had lower summary socioeconomic scores than younger men. Middle-aged women had more obesity and dysmetabolism, while men had more heavy alcohol use. There was greater disease severity with increasing age; with higher cardiac biomarkers, 3-vessel disease, cardiogenic shock, and coronary artery bypass grafting. Older patients had higher rates of death and death or readmission over 4.3 (interquartile range 2.4, 6.0) years of follow-up. Middle-aged women had higher rates of death or any readmission than men, but these differences were not significant after adjustment. Conclusions: These findings indicate a high burden of risk factors in younger adults with STEMI from an inner-city community. Programs to target sociobehavioral factors in disadvantaged settings, including substance abuse, obesity, and risk of HIV, are necessary to more effectively address health disparities in STEMI and its adverse consequences.
AB - Objectives: To compare outcomes by age and sex in race/ethnic minorities presenting with ST-elevation myocardial infarction (STEMI), as studies are limited. Methods: We studied sociodemographics, management, and outcomes in 1208 STEMI patients evaluated for primary percutaneous coronary intervention between 2008 and 2014 at Montefiore Health System (Bronx, NY). A majority of patients self-identified as nonwhite, and nearly two-thirds were young ('45 years) or middle-aged (45-64 years). Results: Risk factors varied significantly across age groups; with more women and non-Hispanic whites, hypertension, diabetes, dyslipidemia, prior cardiovascular disease, non-sinus rhythm, and collagen vascular disease in the older age group (≥65 years); and higher body mass index, smoking, cocaine use, human immunodeficiency virus (HIV) infection and family history of heart disease in the young. Younger women had lower summary socioeconomic scores than younger men. Middle-aged women had more obesity and dysmetabolism, while men had more heavy alcohol use. There was greater disease severity with increasing age; with higher cardiac biomarkers, 3-vessel disease, cardiogenic shock, and coronary artery bypass grafting. Older patients had higher rates of death and death or readmission over 4.3 (interquartile range 2.4, 6.0) years of follow-up. Middle-aged women had higher rates of death or any readmission than men, but these differences were not significant after adjustment. Conclusions: These findings indicate a high burden of risk factors in younger adults with STEMI from an inner-city community. Programs to target sociobehavioral factors in disadvantaged settings, including substance abuse, obesity, and risk of HIV, are necessary to more effectively address health disparities in STEMI and its adverse consequences.
KW - coronary artery disease
KW - myocardial infarction
UR - http://www.scopus.com/inward/record.url?scp=85088579159&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85088579159&partnerID=8YFLogxK
U2 - 10.1002/clc.23412
DO - 10.1002/clc.23412
M3 - Article
C2 - 33460205
AN - SCOPUS:85088579159
VL - 43
SP - 1100
EP - 1109
JO - Clinical Cardiology
JF - Clinical Cardiology
SN - 0160-9289
IS - 10
ER -