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

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