Community incidence rates for STEMI have declined over the past decade, whereas those for non ST-elevation ACS have increased (Figure 1). At present, STEMI comprises approximately 25% to 40% of MI presen- (approximately 7% to 18%) mortality rates from STEMI also have decreased significantly in association with a substantial increase in the frequency of care that includes GDMT and interventions ( defect-free care).13,15 18 In the United States, important regional differences exist in 30-day acute MI hospital mortality and readmission rates for Medicare ben- eficiaries 65 years of age.19 Understanding the reasons for such differences may provide opportunities for performance Approximately 30% of patients with STEMI are women. Female sex was a strong independent predictor of failure to receive reperfusion therapy among patients who had no contraindications in the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Compared with men, women included in the NCDR (National Cardiovascular Data Registry) ACTION Registry GWTG (Get With The Guidelines) pre- sented later after symptom onset, had longer door-to-fibrino- lysis and door-to-balloon (or device) (D2B) times, and less often received aspirin or beta blockers within 24 hours of presentation. 