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Publications

Journal Article Epublish

PubMed: 42194522 DOI: 10.3390/jcm15103560

Persisting Sex Discrepancies in Short-Term Outcomes of Patients with ST-Segment Myocardial Infarction: Results of the ISACS-STEMI COVID-19 Registry.

J Clin Med 15(10)

Authors: Giuseppe De Luca, Stephane Manzo-Silberman, Filippo Zilio, Magdy Algowhary, Berat Uguz, Dinaldo C Oliveira, Vladimir Ganyukov, Zan Zimbakov, Miha Cercek, Lisette Okkels Jensen, Poay Huan Loh, Lucian Calmac, Gerard Roura I Ferrer, Alexandre Quadros, Marek Milewski, Fortunato Scotto D'Uccio, Clemens von Birgelen, Francesco Versaci, Jurrien Ten Berg, Gianni Casella, Aaron Wong Sung Lung, Petr Kala, José Luis Díez Gil, Xavier Carrillo, Maurits Dirksen, Victor M Becerra-Munoz, Michael Kang-Yin Lee, Dafsah Arifa Juzar, Rodrigo de Moura Joaquim, Roberto Paladino, Davor Milicic, Periklis Davlouros, Nikola Bakraceski, Luca Donazzan, Adriaan Kraaijeveld, Gennaro Galasso, Lux Arpad, Lucia Marinucci, Vincenzo Guiducci, Maurizio Menichelli, Alessandra Scoccia, Aylin Hatice Yamac, Kadir Ugur Mert, Xacobe Flores Rios, Tomas Kovarnik, Michal Kidawa, Josè Moreu, Vincent Flavien, Enrico Fabris, Iñigo Lozano Martínez-Luengas … and 41 other authors

Affiliations

  • Division of Cardiology, AOU "Policlinico G. Martino", Department of Clinical and Experimental Medicine, University of Messina, 98121 Messina, Italy.
  • Division of Cardiology, IRCSS Galeazzi-Sant'Ambrogio Hospital, 20157 Milan, Italy.
  • Department of Cardiology, Pitié-Salpêtrière Hospital, Institute of Cardiology, ACTION Study Group, Sorbonne University, 75005 Paris, France.
  • Division of Cardiology, Ospedale Santa Chiara, 38122 Trento, Italy.
  • Division of Cardiology, Assiut University Heart Hospital, Assiut University, Assiut 71524, Egypt.
  • Division of Cardiology, Bursa City Hospital, 16000 Bursa, Turkey.
  • Pronto de Socorro Cardiologico Prof. Luis Tavares, Centro PROCAPE, Federal University of Pernambuco, Recife 50670-901, Brazil.
  • Department of Heart and Vascular Surgery, State Research Institute for Complex Issues of Cardiovascular Diseases, 650000 Kemerovo, Russia.
  • University Clinic for Cardiology, Medical Faculty, Ss' Cyril and Methodius University, 1000 Skopje, North Macedonia.
  • Centre for Intensive Internal Medicine, University Medical Centre, 1000 Ljubljana, Slovenia.
  • Division of Cardiology, Odense Universitets Hospital, 5230 Odense, Denmark.
  • Department of Cardiology, National University Hospital, Singapore 119074, Singapore.
  • Clinic Emergency Hospital, 050098 Bucharest, Romania.
  • Interventional Cardiology Unit, Heart Disease Institute, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain.
  • Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre 90620-001, Brazil.
  • Division of Cardiology, Medical University of Silezia, 40-002 Katowice, Poland.
  • Division of Cardiology, Ospedale del Mare, 80147 Napoli, Italy.
  • Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, 7512 KZ Enschede, The Netherlands.
  • Division of Cardiology, Ospedale Santa Maria Goretti, 04140 Latina, Italy.
  • Division of Cardiology, St Antonius Hospital, 3435 CM Nieuwegein, The Netherlands.
  • Division of Cardiology, Ospedale Maggiore, 40100 Bologna, Italy.
  • Department of Cardiology, National Heart Center, Singapore 169609, Singapore.
  • University Hospital Brno, Medical Faculty of Masaryk University, 63500 Brno, Czech Republic.
  • Department of Cardiology, H. Universitario y Politécnico La Fe, 46026 Valencia, Spain.
  • Department of Cardiology, Hospital Germans Triasi Pujol, 08916 Badalona, Spain.
  • Division of Cardiology, Northwest Clinics, 1815 JD Alkmaar, The Netherlands.
  • Department of Cardiology, Hospital Clínico Universitario Virgen de la Victoria, 291010 Málaga, Spain.
  • Department of Cardiology, Queen Elizabeth Hospital, University of Hong Kong, Hong Kong 999077, China.
  • Department of Cardiology and Vascular Medicine, University of Indonesia National Cardiovascular Center "Harapan Kita", Jakarta 11420, Indonesia.
  • Department of Cardiology, Instituto de Cardiologia de Santa Catarina Praia Comprida, São José 88103-700, Brazil.
  • Division of Cardiology, Clinica Villa dei Fiori, 80011 Acerra, Italy.
  • Department of Cardiology, University Hospital Centre, University of Zagreb, 10000 Zagreb, Croatia.
  • Invasive Cardiology and Congenital Heart Disease, Patras University Hospital, 26504 Patras, Greece.
  • Division of Cardiology Center for Cardiovascular Diseases, 6000 Ohrid, North Macedonia.
  • Division of Cardiology, Ospedale "S. Maurizio", 39100 Bolzano, Italy.
  • Division of Cardiology, University Medical Center, 3684 CX Utrecht, The Netherlands.
  • Division of Cardiology, Ospedale San Giovanni di Dio e Ruggi d'Aragona, 84131 Salerno, Italy.
  • Division of Cardiology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands.
  • Division of Cardiology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", 61121 Pesaro, Italy.
  • Division of Cardiology, AUSL-IRCCS, 42122 Reggio Emilia, Italy.
  • Division of Cardiology, Ospedale "F. Spaziani", 03100 Frosinone, Italy.
  • Division of Cardiology, Ospedale "Sant'Anna", 44124 Ferrara, Italy.
  • Department of Cardiology, Hospital Bezmialem Vakıf University, 34093 Istanbul, Turkey.
  • Division of Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, 26040 Eskisehir, Turkey.
  • Department of Cardiology, Complexo Hospetaliero Universitario La Coruna, 15006 La Coruna, Spain.
  • Department of Cardiology, University Hospital, 12808 Prague, Czech Republic.
  • Department of Cardiology, Central Hospital of Medical University, 91-425 Lodz, Poland.
  • Division of Cardiology, Complejo Hospitalario de Toledo, 45005 Toledo, Spain.
  • Division of Cardiology, Center Hospitalier Universitaire de Lille, 59000 Lille, France.
  • Azienda Ospedaliero-Universitaria Ospedali Riuniti, 34142 Trieste, Italy.
  • Division of Cardiology, Hospital Cabueñes, 33394 Gijon, Spain.

Abstract

Background. Despite technological innovations and improvements in stents and devices, sex-related discrepancies are still reported in the outcomes after ST-segment elevation myocardial infarction (STEMI), depending on biological and sex-specific pathophysiological differences, which have not been completely understood. The aim of the present study was to provide real-world data on the prognostic role of sex among patients with STEMI, enclosed into a recent up-to-date international registry. Methods. The ISACS-STEMI COVID-19 is a large-scale retrospective registry, including STEMI patients treated with mechanical reperfusion between 1 March and 30 June, 2019 and 2020. Patients, treated in 109 centers across Europe, Latin America, Southeast Asia, and North Africa, were grouped according to sex. Primary endpoint: In-hospital mortality; secondary endpoints: Time delay, 30-day mortality, and postprocedural Thrombolysis In Myocardial Infarction (TIMI) 3 flow. Results. We included 16,083 patients, 24.3% females (54.3% hospitalized in 2019, 45.7% in 2020). Women with STEMI were older, more often diabetic and hypertensive (p < 0.001), with a higher prevalence of hypercholesterolemia (p = 0.02), longer ischemia time (p = 0.01), ambulance referral (p = 0.03) and cardiogenic shock at presentation (p = 0.05), but less frequently smokers, with a previous cardiovascular event (p < 0.001) or anterior STEMI (p = 0.03) as compared to males. Preprocedural TIMI 0 flow, multivessel disease, need for thrombectomy (p < 0.001 and p = 0.001, respectively), use of Glycoprotein IIbIIIa inhibitors or cangrelor, radial access and implantation of drug-eluting stents (p < 0.001, p < 0.001 and p = 0.001, respectively) were also more common in men. Impaired postprocedural epicardial reperfusion (TIMI flow 0-2) was observed more frequently in females as compared to males (10% vs. 7.2%; adjusted OR [95% CI] = 1.30 [1.13-1.49], p = 0.01). In-hospital mortality was 5.8%, significantly higher among women (8.3% vs. 5%, p < 0.001, adjusted HR [95% CI] = 1.26 [1.06-1.5], p = 0.01). Similar data were observed for 30-day mortality (10.3% vs. 6.2%, p < 0.001, adjusted HR [95% CI] = 1.22 [1.06-1.38], p = 0.007). Conclusions. Among STEMI patients being treated with the most updated standard of care for primary percutaneous coronary intervention, female sex is still associated with higher complexity and impaired prognosis, displaying suboptimal epicardial reperfusion and increased in-hospital and 30-day mortality.

MeSH

Registries, Stents, Mortality, Myocardial Infarction, Hospital Mortality, St Elevation Myocardial Infarction, Covid-19, Reperfusion, Sex