Sex Disparities in Emergent Reperfusion Timing in Female Patients with Non-ST Elevation Occlusion Myocardial Infarction
Overview
This international, multicenter analysis of 623 consecutive patients with occlusion myocardial infarction (OMI) from five cohorts (2012–2023) compared ECG-to-balloon time between women and men. OMI was confirmed by two expert physicians using ECG, laboratory and coronary angiography data, and patients were grouped by whether they met STEMI criteria. Median ECG-to-balloon time was 48 minutes in STEMI-OMI but 17.1 hours in NSTEMI-OMI. Among NSTEMI-OMI patients, women waited a median of 20.1 hours versus 15.7 hours for men, a 4.4-hour delay, while there was no sex difference in STEMI-OMI.
Key findings
- Of 623 OMI patients, 314 had STEMI-OMI (24% female) and 309 had NSTEMI-OMI (30% female).
- Median ECG-to-balloon time was 48 minutes for STEMI-OMI versus 17.1 hours for NSTEMI-OMI (p<0.001).
- In NSTEMI-OMI, women had a significantly longer median ECG-to-balloon time than men (20.1 vs 15.7 hours, p=0.002), a 4.4-hour delay.
- In STEMI-OMI, ECG-to-balloon time did not differ by sex (47.0 minutes in women vs 50.6 minutes in men, p=0.85).
Published in: ACC.25 – presented as a moderated poster (Journal of the American College of Cardiology, Volume 85, Issue 12, Supplement A)
Published on: 30 March 2025
Background
Sex differences in acute coronary syndrome (ACS) symptom presentation complicate timely diagnosis in female patients. Nearly half of patients with occlusion myocardial infarction (OMI) do not meet STEMI criteria at admission, leading to delayed intervention, a challenge that may be greater for female patients with NSTEMI-OMI. The authors investigated sex-based differences in ECG-to-balloon (E2B) time among OMI patients, categorized by STEMI status.
Methods
A total of 623 consecutive OMI patients (2012–2023) from five international cohorts were included. Two expert physicians confirmed the OMI diagnosis using electrocardiogram (ECG), laboratory and coronary angiography data. Patients were grouped as STEMI-OMI or NSTEMI-OMI and stratified by time to PCI (<2 hours vs >2 hours) and by sex.
Results
Among 314 STEMI-OMI patients (24% female) and 309 NSTEMI-OMI patients (30% female), median E2B time was 48 minutes for STEMI-OMI and 17.1 hours for NSTEMI-OMI (p<0.001). In STEMI-OMI, women had a median E2B time of 47.0 minutes (95% CI 30–78) and men 50.6 minutes (95% CI 30–72) (p=0.85). In NSTEMI-OMI, women had a significantly longer median E2B time of 20.1 hours (95% CI 10.2–48.2) compared with 15.7 hours (95% CI 5.6–28.0) in men (p=0.002).
Conclusion
This international, multicenter analysis highlights a significant 4.4-hour delay to emergent reperfusion in female patients with NSTEMI-OMI. These findings underscore the importance of gender-neutral diagnostic approaches in ACS management.
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