Background: The ambulance system is vital for the early management of patients with ST‐segment–elevation myocardial infarction, reducing delays in diagnosis and treatment. This study examined the impact of transport mode on reperfusion therapy and mortality among patients with ST‐segment–elevation myocardial infarction from 2000 to 2021. Methods: Data from the ACSIS (Acute Coronary Syndrome Israeli Survey) registry 2000 to 2021 were analyzed. Three transport methods of patients with ST‐segment–elevation myocardial infarction were evaluated. The impact on patient outcomes was assessed. Temporal trends from early (2000–2010) and late (2013–2021) periods were compared. Results: Of 8035 patients with ST‐segment–elevation myocardial infarction, 52.9% were transported by mobile intensive care units, 13.1% by basic life support ambulances, and 34% self‐transported. Use of mobile intensive care units increased from 48.7% to 60.9% ( P <0.001), while self‐transport decreased from 36.8% to 28.7% ( P <0.001). Time from hospital arrival to primary percutaneous coronary intervention significantly decreased for mobile intensive care unit patients (60 to 36 minutes; P <0.001) and for basic life support patients (90 to 73 minutes; P =0.002), while self‐transport showed no significant change. Adjusted analysis revealed a decrease in 30‐day major adverse cardiovascular events (odds ratio, 0.53; P <0.001) and 1‐year mortality rates (hazard ratio, 0.84; P < 0.05) for the entire cohort with no difference within or upon comparing transport methods between periods. Primary percutaneous coronary intervention rates and guideline‐directed medical therapy also rose significantly ( P <0.001). Conclusions: Improved major adverse cardiovascular event and mortality rates are attributed to enhanced in‐hospital and postdischarge care, including primary percutaneous coronary intervention and guideline‐directed medical therapy rather than transport improvements, although these contribute to more stable arrival conditions.

Background: Percutaneous left atrial appendage closure (LAAC) provides an alternative to oral anticoagulation (OAC) in atrial fibrillation (AF) patients who are at high bleeding risk. Prior studies have suggested sex-related differences in procedural outcomes, with women demonstrating higher peri-procedural complication rates. Data on long-term outcomes, however, remain inconsistent. Methods: We analyzed 407 consecutive patients with AF who underwent LAAC between 2010 and 2023 in four Israeli medical centers participating in the LEADER registry. Baseline characteristics, procedural data, and clinical outcomes were compared between men and women. The primary efficacy endpoint was ischemic stroke or systemic embolism at 1 year. The primary safety endpoint was a composite of all-cause mortality, procedural complications, or major bleeding at 1 year. Results: Of 407 patients, 285 (70%) were men and 122 (30%) were women. The mean age was 77 ± 8.4 years with similar CHA₂DS₂-VASc and HAS-BLED scores across sexes. Device implantation exceeded 99% in both sexes. Major peri-procedural complications occurred in 6.4% overall, without significant sex-based differences (men 7.0%, women 4.9%, p = 0.51). At 1-year follow-up, Kaplan–Meier estimates for the primary efficacy endpoint of ischemic stroke/systemic embolism (2.6%), the primary safety endpoint (19.2%), major bleeding (8.9%), and all-cause mortality (9.3%) were comparable between men and women (all p > 0.1). Conclusions: In contrast to prior large registries reporting higher peri-procedural risk in women, this real-world multicenter experience demonstrated no significant sex differences in either peri-procedural or long-term outcomes following LAAC. These findings support LAAC as an effective and safe stroke-prevention strategy in AF, irrespective of sex.