title: Sex-related differences in access to care among patients with premature acute coronary syndrome.
abstract: BACKGROUND
  Access to care may be implicated in disparities between men and women in death after acute coronary syndrome, especially among younger adults. We aimed to assess sex-related differences in access to care among patients with premature acute coronary syndrome and to identify clinical and gender-related determinants of access to care.
  
  
  METHODS
  We studied 1123 patients (18-55 yr) admitted to hospital for acute coronary syndrome and enrolled in the GENESIS-PRAXY cohort study. Outcome measures were door-to-electrocardiography, door-to-needle and door-to-balloon times, as well as proportions of patients undergoing cardiac catheterization, reperfusion or nonprimary percutaneous coronary intervention. We performed univariable and multivariable logistic regression analyses to identify clinical and gender-related determinants of timely procedures and use of invasive procedures.
  
  
  RESULTS
  Women were less likely than men to receive care within benchmark times for electrocardiography (≤ 10 min: 29% v. 38%, p = 0.02) or fibrinolysis (≤ 30 min: 32% v. 57%, p = 0.01). Women with ST-segment elevation myocardial infarction (MI) were less likely than men to undergo reperfusion therapy (primary percutaneous coronary intervention or fibrinolysis) (83% v. 91%, p = 0.01), and women with non-ST-segment elevation MI or unstable angina were less likely to undergo nonprimary percutaneous coronary intervention (48% v. 66%, p < 0.001). Clinical determinants of poorer access to care included anxiety, increased number of risk factors and absence of chest pain. Gender-related determinants included feminine traits of personality and responsibility for housework.
  
  
  CONCLUSIONS
  Among younger adults with acute coronary syndrome, women and men had different access to care. Moreover, fewer than half of men and women with ST-segment elevation MI received timely primary coronary intervention. Our results also highlight that men and women with no chest pain and those with anxiety, several traditional risk factors and feminine personality traits were at particularly increased risk of poorer access to care.
authors.forename: Roxanne
authors.initials: R
authors.lastname: Pelletier
authors.forename: Karin H
authors.initials: KH
authors.lastname: Humphries
authors.forename: Avi
authors.initials: A
authors.lastname: Shimony
authors.forename: Simon L
authors.initials: SL
authors.lastname: Bacon
authors.forename: Kim L
authors.initials: KL
authors.lastname: Lavoie
authors.forename: Doreen
authors.initials: D
authors.lastname: Rabi
authors.forename: Igor
authors.initials: I
authors.lastname: Karp
authors.forename: Meytal Avgil
authors.initials: MA
authors.lastname: Tsadok
authors.forename: Louise
authors.initials: L
authors.lastname: Pilote
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D002170:Canada / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends; D013557:Switzerland / Q000453:epidemiology; D015912:Thrombolytic Therapy / Q000379:methods*; D014481:United States / Q000453:epidemiology; D055815:Young Adult