Persistent Sex Disparities in Pre-Hospital Delay Among Patients With STEMI Despite Overall Improvements: Findings From the Chinese Cardiovascular Association Chest Pain Center Registry.
Journal of the American Heart Association · 2026-02-26 · Registry study
Abstract
BACKGROUND: Women with ST-segment-elevation myocardial infarction (STEMI) historically experience longer pre-hospital delays than men. Whether this disparity has narrowed in China remains unknown. METHODS: We analyzed STEMI patients in the Chinese Cardiovascular Association Database-Chest Pain Center (2016-2023). Total pre-hospital delay and its components were analyzed using multivariable quantile regression across three periods (2016-2019; 2020-2022; 2023), adjusting for age, comorbidities, and cardiovascular risk factors. RESULTS: Among 1 104 812 patients, 162 032 (14.7%) were transported by emergency medical services (EMS). Women had consistently longer pre-hospital delays than men (median: 170 versus 124 minutes); the adjusted sex difference at median was 24.44 minutes (95% CI: 22.71-26.16), widening at higher percentiles. Overall delays declined from 2016 to 2019 to 2023, with attenuation during 2020 to 2022. The sex disparities persisted and were most pronounced in patients <80 years and appeared larger in rural settings. In the EMS-transported subgroup, the adjusted median difference was 15.69 minutes (95% CI: 13.24-18.13). Breakdown of delay components indicated that the disparity was driven by EMS call delay (adjusted median difference 13.95 minutes, 95% CI: 11.23-16.67) rather than transportation delay. CONCLUSIONS: Despite overall improvements, sex disparities in pre-hospital delay persisted in China, largely arose before EMS activation. Targeted strategies should prioritize symptom recognition and early EMS activation among women, with rural-tailored implementation.
Tags
Equity & disparities · Rural & remote · Sex & gender · Time intervals