Introduction: Women with STEMI have been shown to experience longer treatment delays (TD) than men, some of which may be due to physician bias. Recently, automated “physician-less” prehospital STEMI activation has been shown to both be safe and effective in reducing TD times (first-medical-contact-to-device, C2D; door-to-device, D2D). We sought to determine whether this same system could also reduce the TD gap between women and men.
Methods: In this retrospective dual-center all-comers observational study of patients with confirmed STEMI, two cohorts were created at Center A: (1) a Traditional Hospital-Based Activation Cohort and (2) an Automated “Physician-less” Prehospital Activation Cohort. A third cohort (3) was established at Center B that employs a similar prehospital algorithm to Center A, but with ECG transmission for real-time physician oversight. The primary outcome was the proportion of women and men with suboptimal (>90 min) D2D times, compared using the chi-square test. C2D and multivariate predictors of suboptimal TD were also evaluated.
Results: Baseline characteristics and TD outcomes are presented in the table. The proportion of women with suboptimal D2D in Cohort 1 was significantly higher compared to men (62% vs. 36%, p<0.01), whereas the proportion of patients with suboptimal D2D was lower and similar between women and men in Cohort 2 (5% vs. 2%, p=0.17). In Cohort 3, women were once again more likely to have suboptimal D2D (19% vs. 2%, p<0.01). A similar pattern was noted for C2D times. There was a strong trend for sex as an independent predictor of suboptimal TD in cohorts with physician involvement (D2D p=0.054; C2D p=0.058), whereas it was not an independent predictor in the “physician-less” activation cohort.
Conclusions: Automated “physician-less” STEMI activation appears to abolish the traditional TD gap between women and men, whereas a similar pre-hospital system with physician involvement did not.