Sex-Based Variations in Clinical Presentation and Door-to-Balloon Times for Acute Coronary Syndrome A Single-Centre Comparative Cohort Across Eighteen Months of Activations

Abstract

Sex-based disparities in acute coronary syndrome (ACS) care have been documented across many health systems, with women often experiencing longer time-to-treatment intervals and worse short-term outcomes than men. We examined eighteen months of consecutive primary-PCI activations at a tertiary cardiac centre (n = 312; 157 women, 155 men) to characterise sex-based differences in clinical presentation, time-to-treatment intervals, and 30-day outcomes. Women were older on arrival (mean 67.2 vs 60.4 years), more likely to report atypical symptoms dyspnoea, fatigue, epigastric pain without classical chest pain, and waited longer at every step from symptom onset to balloon inflation. Median door-to-balloon time was 94 minutes in women compared with 66 minutes in men (p < 0.001). Thirty-day MACE was higher in women (15.3% vs 9.7%, log-rank p = 0.018). Female sex remained an independent predictor of delayed reperfusion in multivariable analysis (adjusted OR 1.92, 95% CI 1.34-2.74) after adjustment for age, presentation pattern, and arrival mode. The findings support sex-aware ACS pathways with embedded recognition prompts and structured audit.

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