{
  "abstract": "Background In rural settings, women with ST-elevation myocardial infarction (STEMI) are less likely to receive timely reperfusion than men. We explore factors that may impact time to reperfusion by sex for patients with STEMI.Methods We conducted a cohort study of adults with STEMI activations from 2016 to 2020 using regional North Carolina STEMI registry data, which included eight rural emergency medical services (EMS) agencies and three percutaneous coronary intervention (PCI) centres. The primary outcome was EMS first medical contact to PCI in ≤90 min. By sex, we evaluated prehospital time intervals (dispatch, response, time-to-ECG, catheterisation laboratory activation, on-scene, transport and total EMS) and door-to-balloon time with clustered Wilcoxon rank-sum tests. We also evaluated agency and patient factors associated with timely reperfusion using generalised estimating equations.Results Of the 365 patients included, 30.1% (110/365) were female with a mean age of 62.5±12.7. Fewer women received PCI within 90 min compared with men (43.6% vs 67.8%, p<0.001). Women also experienced significantly longer total EMS time (42.5 vs 40.0 min, p=0.049) and door-to-balloon time (48.5 vs 40.0 min, p=0.01). Other time intervals were similar. After adjustment, women without exertional symptoms, with diabetes or with hypercholesterolaemia had lower odds of timely reperfusion. Among men, lower odds of timely reperfusion were observed among those without pain, who had catheterisation lab activation between 17:00 and 07:00, who were older or who had farther transport.Conclusion In rural settings, women without exertional chest pain and those with comorbid conditions were less likely to have timely reperfusion. Women experienced significantly longer total EMS time and door-to-balloon time than men.",
  "authors": [
    {
      "affiliations": [
        "Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA"
      ],
      "name": "Michael W Supples"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA"
      ],
      "name": "Randy S Carpenter"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA"
      ],
      "name": "Nicklaus P Ashburn"
    },
    {
      "affiliations": [
        "Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA"
      ],
      "name": "W Mark Brown"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA",
        "Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA"
      ],
      "name": "Anna C Snavely"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA"
      ],
      "name": "Chadwick D Miller"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA"
      ],
      "name": "Jason P Stopyra"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA",
        "Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA",
        "Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA"
      ],
      "name": "Simon A Mahler"
    }
  ],
  "title": "Sex differences in rural prehospital ST-segment elevation myocardial infarction care",
  "uid": "fdc2080b-0d97-5802-b9ff-c1d66ec92be4"
}