Background: Timely revascularization with percutaneous coronary intervention ( PCI ) reduces death following myocardial infarction. We evaluated if a sex gap in symptom‐to‐door ( STD ), door‐to‐balloon ( DTB ), and door‐to‐ PCI time persists in contemporary patients, and its impact on mortality. Methods and Results: From 2013 to 2016 the Victorian Cardiac Outcomes Registry prospectively recruited 13 451 patients (22.5% female) from 30 centers with ST‐segment–elevation myocardial infarction ( STEMI , 47.8%) or non–ST‐segment–elevation myocardial infarction (NSTEMI) (52.2%) who underwent PCI . Adjusted log‐transformed STD and DTB time in the STEMI cohort and STD and door‐to‐ PCI time in the NSTEMI cohort were analyzed using linear regression. Logistic regression was used to determine independent predictors of 30‐day mortality. In STEMI patients, women had longer log‐ STD time (adjusted geometric mean ratio 1.20, 95% CI 1.12‐1.28, P <0.001), log‐ DTB time (adjusted geometric mean ratio 1.12, 95% CI 1.05‐1.20, P =0.001), and 30‐day mortality (9.3% versus 6.5%, P =0.005) than men. Womens’ adjusted geometric mean STD and DTB times were 28.8 and 7.7 minutes longer, respectively, than were mens’ times. Women with NSTEMI had no difference in adjusted STD , door‐to‐ PCI time, or early (<24 hours) versus late revascularization, compared with men. Female sex independently predicted a higher 30‐day mortality (odds ratio 1.67, 95% CI 1.11‐2.49, P =0.01) in STEMI but not in NSTEMI. Conclusions: Women with STEMI have significant delays in presentation and revascularization with a higher 30‐day mortality compared with men. The delay in STD time was 4‐fold the delay in DTB time. Women with NSTEMI had no delay in presentation or revascularization, with mortality comparable to men. Public awareness campaigns are needed to address women's recognition and early action for STEMI .

Introduction The coronavirus 2019 disease (COVID‐19) pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Pre‐existing cardiovascular disease (CVD) increases the morbi...

Background: Women with ST‐segment–elevation myocardial infarction experience delays in reperfusion compared with men with little data on each time component from symptom onset to reperfusion. This study analyzed sex discrepancies in patient delays, prehospital system delays, and hospital delays. Methods and Results: Consecutive patients with ST‐segment–elevation myocardial infarction treated with percutaneous coronary intervention across 30 hospitals in the Victorian Cardiac Outcomes Registry (2013–2018) were analyzed. Data from the Ambulance Victoria Data warehouse were used to perform linkage to the Victorian Cardiac Outcomes Registry for all patients transported via emergency medical services (EMS). The primary end point was EMS call‐to‐door time (prehospital system delay). Secondary end points included symptom‐to‐EMS call time (patient delay), door‐to‐device time (hospital delay), 30‐day mortality, major adverse cardiovascular events, and major bleeding. End points were analyzed according to sex and adjusted for age, comorbidities, cardiogenic shock, cardiac arrest, and symptom onset time. A total of 6330 (21% women) patients with ST‐segment–elevation myocardial infarction were transported by EMS. Compared with men, women had longer adjusted geometric mean symptom‐to‐EMS call times (47.0 versus 44.0 minutes; P <0.001), EMS call‐to‐door times (58.1 versus 55.7 minutes; P <0.001), and door‐to‐device times (58.5 versus 54.9 minutes; P =0.006). Compared with men, women had higher 30‐day mortality (odds ratio [OR], 1.38; 95% CI, 1.06–1.79; P =0.02) and major bleeding (OR, 1.54; 95% CI, 1.08–2.20; P =0.02). Conclusions: Female patients with ST‐segment–elevation myocardial infarction experienced excess delays in patient delays, prehospital system delays, and hospital delays, even after adjustment for confounders. Prehospital system and hospital delays resulted in an adjusted excess delay of 10 minutes compared with men.

Background: Dietary modification is a cornerstone of cardiovascular disease (CVD) prevention. A Mediterranean diet has been associated with a lower risk of CVD but no systematic reviews have evaluated this relationship specifically in women. Objective: To determine the association between higher versus lower adherence to a Mediterranean diet and incident CVD and total mortality in women. Methods: A systematic search of Medline, Embase, CINAHL, Scopus, and Web of Science (2003–21) was performed. Randomised controlled trials and prospective cohort studies with participants without previous CVD were included. Studies were eligible if they reported a Mediterranean diet score and comprised either all female participants or stratified outcomes by sex. The primary outcome was CVD and/or total mortality. A random effects meta-analysis was conducted to calculate pooled hazard ratios (HRs) and confidence intervals (CIs). Results: Sixteen prospective cohort studies were included in the meta-analysis (n=7 22 495 female participants). In women, higher adherence to a Mediterranean diet was associated with a lower CVD incidence (HR 0.76, 95% CI 0.72 to 0.81; I²=39%, p test for heterogeneity=0.07), total mortality (HR 0.77, 95% CI 0.74 to 0.80; I²=21%, p test for heterogeneity=0.28), and coronary heart disease (HR 0.75, 95% CI 0.65 to 0.87; I²=21%, p test for heterogeneity=0.28). Stroke incidence was lower in women with higher Mediterranean diet adherence (HR 0.87, 95% CI 0.76 to 1.01; I²=0%, p test for heterogeneity=0.89), but this result was not statistically significant. Conclusion: This study supports a beneficial effect of the Mediterranean diet on primary prevention of CVD and death in women, and is an important step in enabling sex specific guidelines.