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
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