Reducing gap in pre-hospital delay between women and men presenting with ST-elevation myocardial infarction

Eur J Prev Cardiol. 2023 Aug 21;30(11):1056-1062. doi: 10.1093/eurjpc/zwac294.


Aims: This study aimed to analyse changes in pre-hospital delay over time in women and men presenting with ST-elevation myocardial infarction (STEMI) in Switzerland.

Methods and results: AMIS Plus registry data of patients admitted for STEMI between 2002 and 2019 were analysed using multivariable quantile regression including the following covariates: interaction between sex and admission year, age, diabetes, pain at presentation, myocardial infarction (MI) history, heart failure history, hypertension, and renal disease. Among the 15,350 patients included (74.5% men), the median (interquartile range) delay between 2002 and 2019 was 150 (84; 345) min for men and 180 (100; 414) min for women. The unadjusted median pre-hospital delay significantly decreased over time for both sexes but the decreasing trend was stronger for women. Specifically, the unadjusted sex differences in delay decreased from 60 min in 2002 (P = 0.0042) to 40.5 min in 2019 (P = 0.165). The multivariable model revealed a significant interaction between sex and admission year (P = 0.038) indicating that the decrease in delay was stronger for women (-3.3 min per year) than for men (-1.6 min per year) even after adjustment. The adjusted difference between men and women decreased from 26.93 min in 2002 to -1.97 min for women in 2019.

Conclusion: Over two decades, delay between symptom onset and hospital admission in STEMI decreased significantly for men and women. The decline was more pronounced in women, leading to the sex gap disappearing in the adjusted analysis for 2019.

Keywords: Pre-hospital delay; STEMI; Sex gap.

Plain language summary

Because the delay between onset of heart attack symptoms and hospital admission was higher in women in the past, this study analysed whether pre-hospital delay has shortened in general since 2002 as well as in women and men separately.Our study showed that the pre-hospital delay steadily decreased for both sexes but the decrease was greater in womenAfter considering differences in patient characteristics, such as higher age and less previous heart attacks in women, by 2019 the delay was nearly the same for women and men.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Diabetes Mellitus*
  • Female
  • Hospitalization
  • Hospitals
  • Humans
  • Male
  • Myocardial Infarction* / diagnosis
  • Myocardial Infarction* / epidemiology
  • Myocardial Infarction* / therapy
  • ST Elevation Myocardial Infarction* / diagnosis
  • ST Elevation Myocardial Infarction* / epidemiology
  • ST Elevation Myocardial Infarction* / therapy
  • Sex Factors