Sex disparities in pre-hospital delay in patients with acute myocardial infarction: a systematic review and meta-analysis

Background Pre-hospital delay is a critical determinant of outcomes in acute myocardial infarction (AMI). While sex-based differences in time to presentation have been documented, evidence regarding the association between sex and pre-hospital delay remains inconsistent. This study aimed to determine whether female sex is associated with prolonged pre-hospital delay among patients with AMI. Methods We conducted a systematic review and meta-analysis of studies published between 2000 and 2025, retrieved from PubMed and Web of Science. Included studies reported multivariable-adjusted odds ratios (ORs) for the association between sex (female vs. male) and pre-hospital or patient delay in AMI. Risk of bias was assessed using the Agency for Healthcare Research and Quality checklist. Summary ORs were calculated using inverse variance-weighted random-effects models. Heterogeneity was evaluated using I²and Cochran’s Q statistics. Publication bias was assessed via funnel plots and Egger’s test. Results Twenty-nine studies involving 127,409 AMI patients were analysed (21 evaluated pre-hospital delay, 8 focused on patient delay). Female sex was significantly associated with prolonged pre-hospital delay (OR = 1.17, 95% CI = 1.11 to 1.23, I2=46.3%) and demonstrated an even stronger association with patient delay (OR = 1.23, 95% CI = 1.10 to 1.38, I2=11.9%). These associations persisted across AMI subtypes and after adjustment for confounding factors. Conclusion Significant sex disparities exist in pre-hospital delay among AMI patients, with women experiencing longer delays than men. Addressing these gender disparities is crucial for improving timely recognition and management of AMI, ultimately leading to better clinical outcomes and reduced gender-based healthcare inequalities. Trial registration PROSPERO (ID: CRD420251022182).