Symptom-to-door times in patients presenting with ST elevation myocardial infarction--do ethnic or gender differences exist?

Background: Studies have shown higher in-hospital mortality for female patients and ethnic minorities admitted to hospital with acute ST elevation myocardial infarction (STEMI). Pre-hospital delay is thought to be associated with increased in-hospital mortality.

Aim: To assess the impact of gender and ethnicity on symptom-to-door time (STDT) in patients presenting with STEMI.

Design: Retrospective survey of consecutive patients receiving primary percutaneous coronary intervention between January 2008 and January 2013. A multivariate model was used to adjust for confounders.

Main Outcome Measure: Influence of gender and ethnicity on STDT.

Results: We analysed 1020 patients (75% male, 263 South Asians, 38 Afro Caribbeans and 719 White Europeans.) There was a trend towards longer unadjusted median STDT in women compared with men (132 min vs. 113 min P = 0.07) which disappeared after correction for age and ethnicity (P = 0.15). There was no gender difference in hospital mortality after correction for age (odds ratio 0.69, 95% confidence interval 0.40-1.18, P = 0.17). On linear regression analysis South Asians showed a trend towards longer STDT than other ethnic groups (P = 0.08) however after adjustment for diabetes there was no association between South Asian ethnicity and hospital mortality.

Conclusions: Neither female gender nor ethnicity were shown to be associated with significant pre-hospital delay.