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

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

METHODS: AMIS Plus registry data of patients admitted for STEMI between 2002 and 2019 was 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.

RESULTS: Among the 15,350 patients included (74.5% men), the median (IQR) delay between 2002 and 2019 was 150 (84; 345) minutes for men and 180 (100; 414) minutes for women. The unadjusted median prehospital 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 minutes in 2002 (p = 0.0042) to 40.5 minutes 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 minutes per year) than for men (-1.6 minutes per year) even after adjustment. The adjusted difference between men and women decreased from 26.9 minutes in 2002 to -1.97 minutes for women in 2019.

CONCLUSIONS: 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.