Sex disparities in STEMI care: pre-hospital delay and acute heart failure

Q: What is the clinical evidence from this study?

Study design: Letter. Population: ST-segment elevation myocardial infarction (STEMI). Intervention: Female sex vs. Male sex. Primary outcome: In-hospital mortality.

Artur Dziewierz; Barbara Zdzierak; Tomasz Rakowski

doi:10.1186/s43044-026-00785-w

September 22, 2026The Egyptian Heart JournalOpen Access

Sex disparities in STEMI care: pre-hospital delay and acute heart failure

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Key result

Women with STEMI experience longer pre-hospital delays and ~90% higher in-hospital mortality than men.

7.6% vs. 4.0%

Key Points

Evaluate sex-based disparities in pre-hospital delay, clinical severity, reperfusion strategies, and in-hospital mortality among patients presenting with ST-segment elevation myocardial infarction (STEMI).
Analyzed registry data from the Egyptian cohort of the European Society of Cardiology STEMI Registry comparing clinical presentations and outcomes between women and men.
Assessed time intervals from symptom onset to first medical contact (FMC), utilization of emergency medical services (EMS), Killip classification, and in-hospital mortality.
Women experienced longer pre-hospital delays from symptom onset to FMC (4.2 vs. 3.1 h) and had nearly double the in-hospital mortality rate compared with men (7.6% vs. 4.0%).
Advanced acute heart failure (Killip class III–IV) occurred in 12.8% of women versus 6.9% of men, while primary PCI was performed in 53.6% versus 48.1% and absence of reperfusion occurred in 9.6% versus 7.4%.
Pre-hospital EMS utilization was low across both sexes, with the emergency department serving as the FMC for 83.2% of women and 81.0% of men.

PICO

P

Population

Patients with STEMI from the Egyptian cohort of the European Society of Cardiology STEMI Registry, analyzed for sex disparities in care and outcomes.

E

Exposure / Comparator

Female sex vs Male sex

O

Primary Outcome

In-hospital mortality

Main Result

Absolute Event Rate: 7.6% vs 4%

Limitations

Registry data cannot determine causal mechanisms for the mortality gap, such as delayed presentation, myocardial vulnerability, or comorbidity burden.

Implication

Registry analysis reveals elevated mortality and longer pre-hospital delays in women with STEMI, highlighting emergency medical service underutilization as a key target.

Abstract

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Discussion

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Cite This Study

Dziewierz et al. (2026) conducted a letter in ST-segment elevation myocardial infarction (STEMI). Female sex vs. Male sex was evaluated on In-hospital mortality. Women with STEMI experienced longer pre-hospital delays and had nearly twice the in-hospital mortality compared to men (7.6% vs. 4.0%).

synapsesocial.com/papers/6ab61474406bf401c146a37d https://doi.org/10.1186/s43044-026-00785-w

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Sex disparities in STEMI care: pre-hospital delay and acute heart failure

Key Points

PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Sex disparities in STEMI care: pre-hospital delay and acute heart failure

Key Points

PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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