Abstract Body: Background: Early identification and diagnosis are pivotal in the management of patients with acute myocardial infarction (AMI). The American Heart Association / American College of Cardiology (AHA/ACC) guidelines recommend obtaining an electrocardiogram (ECG) for patients who present to the emergency department (ED) with ischemic symptoms within 10 minutes of arrival. This is an important step in ensuring early administration of reperfusion therapy for those with an ST-elevation myocardial infarction (STEMI). A goal of ≤90 min or ≤ 120 min when transfer is involved is recommended for door-to-balloon (DTB) procedure time to reduce the risk of poor outcomes. However, past research has shown that sex disparities exist in ED triage and timely treatment of patients experiencing an AMI. The aim of this study was to assess sex differences in timely identification and treatment of patients presenting to the ED with AMI.
Methods: We performed a retrospective cross-sectional analysis of 874 STEMI (234 females and 640 males) and 1,650 Non-STEMI (NSTEMI; 556 females, 1095 males) patients that presented to two urban EDs between January 1, 2022, and March 31, 2024. Sex differences in time to ECG (STEMI and NSTEMI) and DTB (STEMI only) were compared continuously, as well as categorically based on AHA/ACC recommendations (ECG delay: >10 min, DTB delay: >90 min or >120 min with transfer). Continuous variables were compared using a multi-factor analysis of variance and categorical variables were tested using chi-square test of association.
Results: Median time to ECG was 4.0 min longer for female compared to male STEMI patients, and 2.5 min longer for female vs male NSTEMI patients (ECG delay: 20.3% of female vs. 11.6% of male STEMI patients and 29.3% female vs. 20.3% of male NSTEMI patients). EMS activation time to ECG was also longer in females (+7.4 min for female STEMI patients and +2.9 min for female NSTEMI patients, compared to male counterparts). Similarly, DTB was 28.0 min longer when no transfer was involved and 15.2 min longer with transfer in female compared to male STEMI patients (DTB delay: 40.6% female vs. 37.0% male STEMI patients).
Conclusion: In AMI patients presenting to the ED, female sex was associated with a significantly longer time to ECG. Female STEMI patients also had longer DTB times, which is associated with poorer outcomes. Initiatives are needed to understand these sex disparities and achieve the AHA/ACC guidelines for both time to ECG and DTB.