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David Weininger,1 Juan Pablo Cordova,2 Eelin Wilson,3 Dayana J Eslava,4 Carlos L Alviar,5 Aleksandr Korniyenko,6 Chirag Pankajkumar Bavishi,7 Mun K Hong,8 Amy Chorzempa,9 John Fox,10 Jacqueline E Tamis-Holland4 1Westchester Medical Center, Valhalla, NY, USA; 2Southshore Cardiovascular Associates, Tampa, FL, USA; 3Montefiore Medical Center, New York, NY, USA; 4Mount Sinai Morningside Hospital, New York, NY, USA; 5NYU Medical Center and Bellevue Hospital Center, New York, NY, USA; 6Univeristy of Texas Health, Tyler, TX, USA; 7University of Missouri Health Care, Columbia, MO, USA; 8Bassett Healthcare Network, Cooperstown, NY, USA; 9Massachusetts General Hospital, Boston, MA, USA; 10Mount Sinai Beth Israel Hospital, New York, NY, USACorrespondence: Jacqueline E Tamis-Holland Tel +1 212-523-2400Fax +1 212-523-5226Email Jacqueline.Tamis-Holland@MountSinai.orgPurpose: Previous studies have shown longer delays from symptom onset to hospital presentation (S2P time) in women than men with acute myocardial infarction. The aim of this study is to understand the reasons for delays in seeking care among women and men presenting with an ST-Segment Elevation Myocardial Infarction (STEMI) through a detailed assessment of the thoughts, perceptions and patterns of behavior.Patients/Methods and Results: A total of 218 patients with STEMI treated with primary angioplasty at four New York City Hospitals were interviewed (24% female; Women: 68.7 ± 13.1 years and men: 60.7 ± 13.8 years) between January 2009 and August 2012. A significantly larger percentage of women than men had no chest pain (62% vs 36%, p< 0.01). Compared to men, a smaller proportion of women thought they were having a myocardial infarction (15% vs 34%, p=0.01). A larger proportion of women than men had S2P time > 90 minutes (72% of women vs 54% of men, p= 0.03). Women were more likely than men to hesitate before seeking help, and more women than men hesitated because they did not think they were having an AMI (91% vs 83%, p=0.04). Multivariate regression analysis showed that female sex (Odds Ratio: 2.46, 95% CI 1.10– 5.60 P=0.03), subjective opinion it was not an AMI (Odds Ratio 2.44, 95% CI 1.20– 5.0, P=0.01) and level of education less than high school (Odds ratio 7.21 95% CI 1.59– 32.75 P=0.01) were independent predictors for S2P > 90 minutes.Conclusion: Women with STEMI have longer pre-hospital delays than men, which are associated with a higher prevalence of atypical symptoms and a lack of belief in women that they are having an AMI. Greater focus should be made on educating women (and men) regarding the symptoms of STEMI, and the importance of a timely response to these symptoms.Keywords: women, awareness, acute myocardial infarction, symptoms