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. 2023 Jan 23;12(3):896.
doi: 10.3390/jcm12030896.

Gender Difference in the Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI: Results of the ISACS-STEMI COVID-19 Registry

Giuseppe De Luca  1   2 , Stephane Manzo-Silberman  3 , Magdy Algowhary  4 , Berat Uguz  5 , Dinaldo C Oliveira  6 , Vladimir Ganyukov  7 , Oliver Busljetik  8 , Miha Cercek  9 , Lisette Okkels  10 , Poay Huan Loh  11 , Lucian Calmac  12 , Gerard Roura I Ferrer  13 , Alexandre Quadros  14 , Marek Milewski  15 , Fortunato Scotto di Uccio  16 , Clemens von Birgelen  17 , Francesco Versaci  18 , Jurrien Ten Berg  19 , Gianni Casella  20 , Aaron Wong Sung Lung  21 , Petr Kala  22 , José Luis Díez Gil  23 , Xavier Carrillo  24 , Maurits Dirksen  25 , Victor Becerra  26 , Michael Kang-Yin Lee  27 , Dafsah Arifa Juzar  28 , Rodrigo de Moura Joaquim  29 , Roberto Paladino  30 , Davor Milicic  31 , Periklis Davlouros  32 , Nikola Bakraceski  33 , Filippo Zilio  34 , Luca Donazzan  35 , Adriaan Kraaijeveld  36 , Gennaro Galasso  37 , Lux Arpad  38 , Lucia Marinucci  39 , Vincenzo Guiducci  40 , Maurizio Menichelli  41 , Alessandra Scoccia  42 , Aylin Hatice Yamac  43 , Kadir Ugur Mert  44 , Xacobe Flores Rios  45 , Tomas Kovarnik  46 , Michal Kidawa  47 , Josè Moreu  48 , Vincent Flavien  49 , Enrico Fabris  50 , Iñigo Lozano Martínez-Luengas  51 , Marco Boccalatte  52 , Francisco Bosa Ojeda  53 , Carlos Arellano-Serrano  54 , Gianluca Caiazzo  55 , Giuseppe Cirrincione  56 , Hsien-Li Kao  57 , Juan Sanchis Forés  58 , Luigi Vignali  59 , Helder Pereira  60 , Santiago Ordoñez  61 , Alev Arat Özkan  62 , Bruno Scheller  63 , Heidi Lehtola  64 , Rui Teles  65 , Christos Mantis  66 , Ylitalo Antti  67 , João António Brum Silveira  68 , Cesar Rodrigo Zoni  69 , Ivan Bessonov  70 , Giuseppe Uccello  71 , George Kochiadakis  72 , Dimitrios Alexopulos  73 , Carlos E Uribe  74 , John Kanakakis  75 , Benjamin Faurie  76 , Gabriele Gabrielli  77 , Alejandro Gutierrez Barrios  78 , Juan Pablo Bachini  79 , Alex Rocha  80 , Frankie C C Tam  81 , Alfredo Rodriguez  82 , Antonia Anna Lukito  83 , Veauthyelau Saint-Joy  84 , Gustavo Pessah  85 , Andrea Tuccillo  16 , Alfonso Ielasi  2 , Giuliana Cortese  86 , Guido Parodi  87 , Mohamed Abed Bouraghda  88 , Marcia Moura  14 , Elvin Kedhi  89 , Pablo Lamelas  61 , Harry Suryapranata  90 , Matteo Nardin  91 , Monica Verdoia  92
Affiliations

Gender Difference in the Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI: Results of the ISACS-STEMI COVID-19 Registry

Giuseppe De Luca et al. J Clin Med. .

Abstract

Background: Several reports have demonstrated the impact of the COVID-19 pandemic on the management and outcome of patients with ST-segment elevation myocardial infarction (STEMI). The aim of the current analysis is to investigate the potential gender difference in the effects of the COVID-19 pandemic on mechanical reperfusion and 30-day mortality for STEMI patients within the ISACS-STEMI COVID-19 Registry.

Methods: This retrospective multicenter registry was performed in high-volume primary percutaneous coronary intervention (PPCI) centers on four continents and included STEMI patients undergoing PPCIs in March-June 2019 and 2020. Patients were divided according to gender. The main outcomes were the incidence and timing of the PPCI, (ischemia time ≥ 12 h and door-to-balloon ≥ 30 min) and in-hospital or 30-day mortality.

Results: We included 16683 STEMI patients undergoing PPCIs in 109 centers. In 2020 during the pandemic, there was a significant reduction in PPCIs compared to 2019 (IRR 0.843 (95% CI: 0.825-0.861, p < 0.0001). We did not find a significant gender difference in the effects of the COVID-19 pandemic on the numbers of STEMI patients, which were similarly reduced from 2019 to 2020 in both groups, or in the mortality rates. Compared to prepandemia, 30-day mortality was significantly higher during the pandemic period among female (12.1% vs. 8.7%; adjusted HR [95% CI] = 1.66 [1.31-2.11], p < 0.001) but not male patients (5.8% vs. 6.7%; adjusted HR [95% CI] = 1.14 [0.96-1.34], p = 0.12).

Conclusions: The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a 16% reduction in PPCI procedures similarly observed in both genders. Furthermore, we observed significantly increased in-hospital and 30-day mortality rates during the pandemic only among females. Trial registration number: NCT 04412655.

Keywords: COVID-19; ST-segment elevation myocardial infarction; gender; percutaneous coronary intervention.

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Conflict of interest statement

The authors declare no conflict of interest concerning the submitted study.

Figures

Figure 2
Figure 2
Bar graphs on the left side show the association between the year of intervention and time delays (ischemia times longer than 12 h in left upper graph; door-to-balloon times longer than 30 min in left lower graph). Bar Graphs on the right side show the association between the year of intervention with in-hospital (right upper graph) and 30-day mortality (right lower graph) rates.
Figure 1
Figure 1
Box-and-whisker plot (on the left) showing the numbers of STEMI patients treated by mechanical reperfusion per million inhabitants/year in 2019 and 2020. The right graph shows the incidence rate ratio with 95% confidence intervals across each center.
Figure 3
Figure 3
Kaplan–Meier survival curves of STEMI patients treated in 2019 and 2020.
See this image and copyright information in PMC

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