Sex differences in rural prehospital ST-segment elevation myocardial infarction care
Michael W Supples1, Randy S Carpenter2, Nicklaus P Ashburn2
1Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA michael.supples@wfusm.edu.
Emergency Medicine Journal : EMJ
|November 20, 2025
Summary
Women with ST-elevation myocardial infarction (STEMI) in rural areas face delays in reperfusion therapy. Factors like lack of chest pain and comorbidities reduce timely treatment for women, impacting outcomes.
Area of Science:
- Cardiology
- Public Health
- Health Equity
Background:
- Rural women with ST-elevation myocardial infarction (STEMI) experience disparities in receiving timely reperfusion therapy compared to men.
- Understanding sex-based differences in STEMI care is crucial for improving outcomes in underserved populations.
Purpose of the Study:
- To investigate factors influencing reperfusion time disparities between men and women with STEMI in rural settings.
- To analyze prehospital and in-hospital time intervals by sex for STEMI patients.
Main Methods:
- A cohort study utilized North Carolina STEMI registry data from 2016-2020, including rural EMS agencies and PCI centers.
- Evaluated prehospital times (dispatch to transport) and door-to-balloon times, comparing outcomes between sexes.
- Generalized estimating equations assessed patient and agency factors associated with timely reperfusion.
Main Results:
- Fewer women (43.6%) received percutaneous coronary intervention (PCI) within 90 minutes compared to men (67.8%).
- Women experienced significantly longer total EMS time and door-to-balloon times.
- Factors like absence of exertional symptoms, diabetes, and hypercholesterolemia were associated with lower odds of timely reperfusion in women.
Conclusions:
- Rural women, particularly those without exertional chest pain or with comorbidities, are less likely to receive timely reperfusion for STEMI.
- Significant delays in total EMS time and door-to-balloon time were observed in women compared to men.
- Addressing sex-specific barriers is essential for improving STEMI treatment equity in rural areas.
Keywords:
Emergency MedicineHealthcare Disparitiesacute myocardial infarctemergency ambulance systemsremote and rural medicineMore Related Videos
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