title: Sex disparities in pre-hospital and hospital treatment of ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  To determine whether sex disparities exist in pre-hospital and hospital time to treatment in patients with ST-segment elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  Evidence suggests that women experience poorer quality of care for STEMI.
  
  
  METHODS
  A retrospective cohort study was conducted on 177 consecutive patients with STEMI who received primary percutaneous coronary intervention at a rural, tertiary medical center between January 2006 and October 2009. A subgroup analysis was conducted to evaluate time to treatment during a period of no-focused process improvement compared with a time period of focused, non–sex-specific process improvement; the post period included implementation of the STEMI process upgrade (STEP-UP) quality-improvement (QI) program.
  
  
  RESULTS
  Median first-emergency-medical-services-contact-to-balloon (E2B) angioplasty time was significantly longer for women compared with men. A Cox proportional hazards model revealed that men had a significantly shorter E2B time than women. After adjustment for differences between sex groups at presentation, the effect of sex on E2B was no longer statistically significant. A similar effect was observed in door-to-balloon (D2B) angioplasty time. The subgroup analysis revealed that from baseline, both men and women experienced improvement in E2B time after implementation of the STEP-UP QI program. Men and women also experienced improvement in D2B time after implementation of the STEP-UP QI program.
  
  
  CONCLUSIONS
  Women with STEMI experienced significantly longer E2B and D2B times compared with men with STEMI, although these differences did not persist after adjustment for differences between sex groups at presentation. In addition to standard STEMI-care QI practices, sex-specific processes and interventions at the systems level may be needed to improve time to treatment for women with STEMI.
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA. michael.ericson.rezaee@gmail.com
authors.forename: Michael E
authors.initials: ME
authors.lastname: Rezaee
authors.forename: Jeremiah R
authors.initials: JR
authors.lastname: Brown
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Conley
authors.forename: Tamara A
authors.initials: TA
authors.lastname: Anderson
authors.forename: Rosemary M
authors.initials: RM
authors.lastname: Caron
authors.forename: Nathaniel W
authors.initials: NW
authors.lastname: Niles
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004632:Emergency Medical Services; D005260:Female; D054625:Healthcare Disparities; D006780:Hospitals, Rural; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000628:therapy*; D009513:New Hampshire; D062645:Percutaneous Coronary Intervention; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D016387:Women's Health