Sex Disparities in Acute Myocardial Infarction Diagnosis and Treatment

This study sought to assess sex differences in timely diagnosis (time-to-ECG) and treatment (time-to-percutaneous coronary intervention (PCI)) of ST-elevation myocardial infarction (STEMI) and Non-STEMI (NSTEMI) patients utilizing a retrospective cross-sectional analysis of 1,098 STEMI (306 females and 792 males) and 2,179 NSTEMI (747 females, 1,432 males) patients that presented to 2 urban EDs between January 2022 and December 2024 was performed. Sex differences in time-to-ECG were assessed in both STEMI and NSTEMI patients, whereas differences in time-to-PCI were assessed in STEMI patients only. Time-to-ECG and time-to-PCI were compared continuously, as well as categorically (ECG delay = time-to-ECG >10 min and PCI delay = time-to-PCI >90 min or >120 min when a transfer occurred). Median time-to-ECG was 3.0 min shorter for male STEMI and NSTEMI patients. Males also had a reduced likelihood of an ECG delay (OR: 0.64 [95% CI 0.51 to 0.82]). Sex disparities remained when assessing only patients with a chief complaint of chest pain (OR:0.74 [95% CI 0.56 to 0.97]). Male STEMI patients also had a shorter wait time for PCI compared to females (walk-in: 1:26:00 vs 1:41:00, transfer: 2:19:30 vs 2:44:30, respectively). However, sex was not a significant predictor of PCI delay after controlling for time-to-ECG. In conclusion, sex disparities were found in time-to-ECG for STEMI and NSTEMI patents, as well as time-to-PCI for STEMI patients. However, sex was not significantly associated with PCI delay after controlling for time-to-ECG. This highlights the importance of timely diagnosis to ensure timely revascularization in acute myocardial infarction patients.