title: Sex differences in STEMI activation for patients presenting to the ED 1939.
abstract: OBJECTIVE
  The objective was to determine whether sex was independently associated with door to ST-elevation myocardial infarction (STEMI) activation time. We hypothesized that women are more likely to experience longer delays to STEMI activation than men.
  
  
  METHODS
  We conducted a retrospective cohort study of adults ≥18 years who underwent STEMI activation at 3 urban emergency departments between 2010 and 2014. The Wilcoxon rank sum test and logistic regression were used to compare men and women regarding time to activation and proportion with times <15 minutes, respectively.
  
  
  RESULTS
  Of 400 eligible patients, we excluded 61 (15%) with prehospital activations, 44 (11%) arrests, and 3 (1%) transfers. Of the remaining 292 patients, mean age was 61±13 years, 64% were men, 57% were black, and 37% arrived by ambulance. Median door to STEMI activation time was 7.0 minutes longer for women than for men (25.5 vs 18.5 minutes, P=.028). In addition, men were more likely than women to have a door to STEMI activation time <15 minutes (45% vs 28%, P=.006). After adjusting for race, hospital site, Emergency Severity Index triage level, arrival mode, and chief concern of chest pain, the odds of men having STEMI activation times <15 minutes were 1.9 times more likely than women.
  
  
  CONCLUSIONS
  Women have longer median door to STEMI activation times than men. A significantly lower proportion of women (28% vs 45%) are treated per American Heart Association guidelines of door to STEMI activation <15 minutes when compared with men, adjusting for confounders. Further investigation may identify possible etiology of bias and potential areas for intervention.
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Choi
authors.affiliation: Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Frances S
authors.initials: FS
authors.lastname: Shofer
authors.affiliation: Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. Electronic address: millsa@uphs.upenn.edu.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Mills
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy; D012737:Sex Factors; D013997:Time Factors