What does this research mean for the field?

Women with STEMI experience longer pre-hospital delays than men, with an adjusted median difference of 24.44 minutes, despite overall improvements in pre-hospital delay times. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

To examine whether sex disparities in pre-hospital delays for STEMI patients have changed in China.

February 28, 2026Open Access

Persistent Sex Disparities in Pre‐Hospital Delay Among Patients With STEMI Despite Overall Improvements: Findings From the Chinese Cardiovascular Association Chest Pain Center Registry

Key Result

Women with STEMI in China had a 24.44-minute longer median pre-hospital delay than men, mainly due to EMS call delay, despite overall delay improvements from 2016 to 2023.

Key Points

To examine whether sex disparities in pre-hospital delays for STEMI patients have changed in China.
Analyzed STEMI patient data from the Chinese Cardiovascular Association Database (2016–2023)
Used multivariable quantile regression to assess pre-hospital delays
Considered factors like age, comorbidities, and cardiovascular risk factors
Women had longer pre-hospital delays than men, with a median difference of 24.44 minutes
Overall pre-hospital delays decreased from 2016 to 2023, but disparities persisted, especially in those <80 years
Disparity was largely due to delays in EMS call rather than transportation delays

Structured PICO

Population

1,104,812 patients with ST-segment-elevation myocardial infarction (STEMI) from the Chinese Cardiovascular Association Database-Chest Pain Center (2016-2023).

Outcome

Total pre-hospital delay and its components

Women with STEMI in China continue to experience significantly longer pre-hospital delays than men, primarily driven by delays in EMS activation.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background Women with ST‐segment–elevation myocardial infarction (STEMI) historically experience longer pre‐hospital delays than men. Whether this disparity has narrowed in China remains unknown. Methods We analyzed STEMI patients in the Chinese Cardiovascular Association Database‐Chest Pain Center (2016–2023). Total pre‐hospital delay and its components were analyzed using multivariable quantile regression across three periods (2016–2019; 2020–2022; 2023), adjusting for age, comorbidities, and cardiovascular risk factors. Results Among 1 104 812 patients, 162 032 (14.7%) were transported by emergency medical services (EMS). Women had consistently longer pre‐hospital delays than men (median: 170 versus 124 minutes); the adjusted sex difference at median was 24.44 minutes (95% CI: 22.71–26.16), widening at higher percentiles. Overall delays declined from 2016 to 2019 to 2023, with attenuation during 2020 to 2022. The sex disparities persisted and were most pronounced in patients <80 years and appeared larger in rural settings. In the EMS‐transported subgroup, the adjusted median difference was 15.69 minutes (95% CI: 13.24–18.13). Breakdown of delay components indicated that the disparity was driven by EMS call delay (adjusted median difference 13.95 minutes, 95% CI: 11.23–16.67) rather than transportation delay. Conclusions Despite overall improvements, sex disparities in pre‐hospital delay persisted in China, largely arose before EMS activation. Targeted strategies should prioritize symptom recognition and early EMS activation among women, with rural‐tailored implementation.