title: Temporal trends in patient and treatment delay among men and women presenting with ST-elevation myocardial infarction.
abstract: BACKGROUND
  over the last decade, there have been major changes in the treatment of ST-elevation myocardial infarction (STEMI). Whether these have resulted in changes in sex differences in time to treatment is unknown. We examined temporal trends in time to reperfusion therapy among men and women with STEMI.
  
  
  METHODS
  the study includes 2 cohorts of STEMI patients presenting to a large metropolitan region during the periods August 24, 2000, to August 20, 2002 (Cohort1, n = 753), and August 25, 2006, to December 31, 2008 (Cohort2, n = 885).
  
  
  RESULTS
  in both cohorts, compared with men, women were significantly older and had more comorbidities. Rate of emergency medical services use among women increased from 55% in Cohort1 to 66% in Cohort2 (P = .02). Median time from symptom onset to first medical contact was 84 minutes among men and 121 minutes among women (P < .01) in Cohort1 and 59 minutes among men and 81 minutes among women (P < .01) in Cohort2. Median door-to-balloon time was significantly longer among women compared with men in Cohort2. After multivariable adjustment, female sex was associated with a 34% (or 27-minute) increase in time from symptom onset to first medical contact and with a 23% (or 13-minute) increase in time from hospital arrival to reperfusion therapy.
  
  
  CONCLUSIONS
  in the last decade, there have been significant reductions in patient and system delay, especially among women. However, women continue to have longer presentation and treatment times, suggesting that there continue to be opportunities for improvement.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. pkaul@ualberta.ca
authors.forename: Padma
authors.initials: P
authors.lastname: Kaul
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
authors.forename: Sunil
authors.initials: S
authors.lastname: Sookram
authors.forename: Becky K
authors.initials: BK
authors.lastname: Leung
authors.forename: Neil
authors.initials: N
authors.lastname: Brass
authors.forename: Robert C
authors.initials: RC
authors.lastname: Welsh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome