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.

ACTION Study Group Institute of Cardiology Hôpital Pitié Salpêtrière Sorbonne University 75651 Paris France

Azienda Ospedaliera Lavagna 16033 Lavagna Italy

Azienda Ospedaliero Universitaria Ospedali Riuniti 34142 Trieste Italy

Cardiology Department Hospital Garcia de Orta Pragal 2805 267 Almada Portugal

Cardiology Division Department of Internal Medicine National Taiwan University Hospital Tapei 8865600 Taiwan

Cardiology Institute Istanbul University 34000 Instanbul Turkey

Cardiovascular Department Pelita Harapan University Heart Center Siloam Lippo Village Hospital Tangerang Banten 15810 Indonesia

Center for Cardiovascular Diseases 6000 Ohrid North Macedonia

Center Hospitalier d'Antibes Juan Les Pins 06600 Antibes France

Central Hospital of Medical University of Lodz 90 008 Lodz Poland

Clinic Emergency Hospital of Bucharest 014461 Bucharest Romania

Complexo Hospetaliero Universitario La Coruna 15001 La Coruna Spain

Department of Cardiology and Cardiovascular Interventions Instituto Nacional de Cirugía Cardíaca Montevideo 11700 Uruguay

Department of Cardiology and Vascular Medicine University of Indonesia National Cardiovascular Center Harapan Kita Jakarta 11420 Indonesia

Department of Cardiology Bezmialem Vakif University Hospital 34093 Istanbul Turkey

Department of Cardiology Medical Center Ljubljana 1000 Ljubljana Slovenia

Department of Cardiology Medisch Spectrum Twente Thoraxcentrum Twente 7541 Enschede The Netherlands

Department of Cardiology National Heart Center Singapore 169609 Singapore

Department of Cardiology National University Hospital Singapore 117597 Singapore

Department of Cardiology Queen Elizabeth Hospital University of Hong Kong Hong Kong

Department of Cardiology Queen Mary Hospital University of Hong Kong Hong Kong

Department of Cardiology University Hospital Centre University of Zagreb 10000 Zagreb Croatia

Department of Heart and Vascular Surgery State Research Institute for Complex Issues of Cardiovascular Diseases 650000 Kemerovo Russia

Department of Internal Medicine Ospedale Riuniti 25121 Brescia Italy

Department of Statistical Sciences University of Padova 35121 Padova Italy

Department of Teaching and Research Instituto de Cardiología de Corrientes Juana F Cabral Corrientes W3400CDS Argentina

Division of Cardiology 3584 Utrecht The Netherlands

Division of Cardiology Alexandra Hospital 10431 Athens Greece

Division of Cardiology AOU Policlinico G Martino Department of Clinical and Experimental Medicine University of Messina 98124 Messina Italy

Division of Cardiology Assiut University Heart Hospital Assiut University Asyut 71515 Egypt

Division of Cardiology Attikon University Hospital 10431 Athens Greece

Division of Cardiology AUSL IRCCS Reggio Emilia 42121 Reggio Emilia Italy

Division of Cardiology Azienda Ospedaliera Ospedali Riuniti Marche Nord 61121 Pesaro Italy

Division of Cardiology Blida University Hospital Blida 09000 Algeria

Division of Cardiology Bursa City Hospital 16000 Bursa Turkey

Division of Cardiology Center Hospitalier Universitaire de Lille 59000 Lille France

Division of Cardiology Clinica Villa dei Fiori 80011 Acerra Italy

Division of Cardiology Clinical and Experimental Interventional Cardiology University of Saarland 66123 Saarbrücken Germany

Division of Cardiology Complejo Hospitalario de Toledo 45001 Toledo Spain

Division of Cardiology Faculty of Medicine Eskisehir Osmangazi University 02640 Eskisehir Turkey

Division of Cardiology Groupe Hospitalier Mutualiste de Grenoble 38000 Grenoble France

Division of Cardiology Heart Centre Turku 20521 Turku Finland

Division of Cardiology Hopital Erasmus Universitè Libre de Bruxelles 1070 Brussels Belgium

Division of Cardiology Hospiatl Cordoba Cordoba 5000 Argentina

Division of Cardiology Hospital Cabueñes 33201 Gijon Spain

Division of Cardiology Hospital Clinico Universitario de Valencia 46010 Valencia Spain

Division of Cardiology Hospital de Santa Cruz CHLO Nova Medical School CEDOC 1000 Lisbon Portugal

Division of Cardiology Hospital de Santo António 4099 001 Porto Portugal

Division of Cardiology Hospital Puerta de Hierro Majadahonda 28222 Majadahonda Spain

Division of Cardiology Hospital Puerta del Mar 11001 Cadiz Spain

Division of Cardiology Hospital Universitario de Canarias 38001 Santa Cruz de Tenerife Spain

Division of Cardiology Kontantopoulion Hospital 10431 Athens Greece

Division of Cardiology Medical University of Silezia 40 002 Katowice Poland

Division of Cardiology Northwest Clinics 1811 Alkmaar The Netherlands

Division of Cardiology Nuovo Galeazzi Sant'Ambrogio Hospital 20161 Milan Italy

Division of Cardiology Odense Universitets Hospital 5000 Odense Denmark

Division of Cardiology Ospedale A Manzoni 23900 Lecco Italy

Division of Cardiology Ospedale Civico Arnas 90100 Palermo Italy

Division of Cardiology Ospedale degli Infermi ASL 13900 Biella Italy

Division of Cardiology Ospedale del Mare 00156 Napoli Italy

Division of Cardiology Ospedale F Spaziani 03100 Frosinone Italy

Division of Cardiology Ospedale G Moscati 81031 Aversa Italy

Division of Cardiology Ospedale Maggiore Bologna 40100 Bologna Italy

Division of Cardiology Ospedale S Maurizio Bolzano 39100 Bolzano Italy

Division of Cardiology Ospedale San Giovanni di Dio e Ruggi d'Aragona 84070 Salerno Italy

Division of Cardiology Ospedale Sant'Anna 44121 Ferrara Italy

Division of Cardiology Ospedale Santa Chiara di Trento 38014 Trento Italy

Division of Cardiology Ospedale Santa Maria delle Grazie 80078 Pozzuoli Italy

Division of Cardiology Ospedale Santa Maria Goretti Latina 04100 Latina Italy

Division of Cardiology Otamendi Hospital Buenos Aires 1001 Argentina

Division of Cardiology Oulu University Hospital 90220 Oulu Finland

Division of Cardiology Radboud University Medical Center 6525 Nijmegen The Netherlands

Division of Cardiology St Antonius Hospital 3434 Nieuwegein The Netherlands

Division of Cardiology Universidad UPB Universidad CES Medellín 050001 Colombia

Hospital Clínico Universitario Virgen de la Victoria 29000 Malaga Spain

Hospital Germans Triasi Pujol 8918 Badalona Spain

Instituto Cardiovascular de Buenos Aires Buenos Aires 1428 Argentina

Instituto de Cardiologia de Santa Catarina Praia Comprida São José 88103 901 Brazil

Instituto de Cardiologia do Rio Grande do Sul Porto Alegre 90040 371 Brazil

Instituto de Cardiologia Integral Montevideo 11700 Uruguay

Interventional Cardiology Unit Azienda Ospedaliera Sanitaria 43121 Parma Italy

Interventional Cardiology Unit Azienda Ospedaliero Universitaria Ospedali Riuniti 60100 Ancona Italy

Interventional Cardiology Unit Heart Disease Institute Hospital Universitari de Bellvitge 08016 Barcelona Spain

Invasive Cardiology and Congenital Heart Disease Patras University Hospital 26221 Patras Greece

Iraklion University Hospital 70001 Crete Greece

Maastricht University Medical Center 6229 Maastricht The Netherlands

Pronto de Socorro Cardiologico Prof Luis Tavares Centro PROCAPE Federal University of Pernambuco Recife 50670 901 Brazil

Sección de la Unidad de Hemodinámica H Universitario y Politécnico La Fe 46001 Valencia Spain

Tyumen Cardiology Research Center Tomsk National Research Medical Center Russian Academy of Science 634000 634538 Tomsk Russia

University Clinic for Cardiology Medical Faculty Ss' Cyril and Methodius University 1000 Skopje North Macedonia

University Hospital Brno Medical Faculty of Masaryk University 60200 Brno Czech Republic

University Hospital Prague 12808 Prague Czech Republic

Zobrazit více v PubMed

Axenhus M., Schedin-Weiss S., Winblad B., Wimo A. Changes in mortality trends amongst common diseases during the COVID-19 pandemic in Sweden. Scand. J. Public Health. 2021;50:748–755. doi: 10.1177/14034948211064656. PubMed DOI PMC

Coronavirus (COVID-19) Deaths. [(accessed on 31 January 2022)]. Available online: https://ourworldindata.org/covid-deaths.

Garcia S., Albaghdadi M.S., Meraj P.M., Schmidt C., Garberich R., Jaffer F.A., Dixon S., Rade J.J., Tannenbaum M., Chambers J., et al. Reduction in ST-Segment Elevation Cardiac Catheterization Laboratory Activations in the United States during COVID-19 Pandemic. J. Am. Coll. Cardiol. 2020;75:2871–2872. doi: 10.1016/j.jacc.2020.04.011. PubMed DOI PMC

Tam C.F., Cheung K.S., Lam S., Wong A., Yung A., Sze M., Lam Y.M., Chan C., Tsang T.C., Tsui M., et al. Impact of Coronavirus Disease 2019 (COVID-19) Outbreak on ST-Segment-Elevation Myocardial Infarction Care in Hong Kong, China. Circ. Cardiovasc Qual. Outcomes. 2020;13:e006631. doi: 10.1161/CIRCOUTCOMES.120.006631. PubMed DOI PMC

Piccolo R., Bruzzese D., Mauro C., Aloia A., Baldi C., Boccalatte M., Bottiglieri G., Briguori C., Caiazzo G., Calabrò P., et al. Population Trends in Rates of Percutaneous Coronary Revascularization for Acute Coronary Syndromes Associated with the COVID-19. Outbreak Circ. 2020;141:2035–2037. doi: 10.1161/CIRCULATIONAHA.120.047457. PubMed DOI PMC

Stefanini G.G., Montorfano M., Trabattoni D., Andreini D., Ferrante G., Ancona M., Metra M., Curello S., Maffeo D., Pero G., et al. ST-Elevation Myocardial Infarction in Patients with COVID-19: Clinical and Angiographic. Outcomes Circ. 2020;141:2113–2116. doi: 10.1161/CIRCULATIONAHA.120.047525. PubMed DOI PMC

De Luca G., Suryapranata H., Ottervanger J.P., Antman E.M. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: Every minute of delay counts. Circulation. 2004;109:1223–1225. doi: 10.1161/01.CIR.0000121424.76486.20. PubMed DOI

Jain V., Gupta K., Bhatia K., Bansal A., Arora S., Khandelwal A.K., Rosenberg J.R., Levisay J.P., Tommaso C.L., Ricciardi M.J., et al. Management of STEMI during the COVID-19 pandemic: Lessons learned in 2020 to prepare for 2021. Trends Cardiovasc. Med. 2021;31:135–140. doi: 10.1016/j.tcm.2020.12.003. PubMed DOI PMC

De Luca G., Verdoia M., Cercek M., Jensen L.O., Vavlukis M., Calmac L., Johnson T., Ferrer G.R., Ganyukov V., Wojakowski W., et al. Impact of COVID-19 Pandemic on Mechanical Reperfusion for Patients With STEMI. J. Am. Coll. Cardiol. 2020;76:2321–2330. doi: 10.1016/j.jacc.2020.09.546. PubMed DOI PMC

Wang D., Hu B., Hu C., Zhu F., Liu X., Zhang J., Wang B., Xiang H., Cheng Z., Xiong Y., et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323:1061–1069. doi: 10.1001/jama.2020.1585. PubMed DOI PMC

Cai H. Sex difference and smoking predisposition in patients with COVID-19. Lancet Respir Med. 2020;8:e20. doi: 10.1016/S2213-2600(20)30117-X. PubMed DOI PMC

Ferrante G., Barbieri L., Sponzilli C., Lucreziotti S., Salerno Uriarte D., Centola M., Verdoia M., Carugo S. Predictors of Mortality and Long-Term Outcome in Patients with Anterior STEMI: Results from a Single Center Study. J. Clin. Med. 2021;10:5634. doi: 10.3390/jcm10235634. PubMed DOI PMC

Verdoia M., Suryapranata H., Damen S., Camaro C., Benit E., Barbieri L., Rasoul S., Liew H.B., Polad J., Ahmad W.A.W., et al. Gender differences with short-term vs 12 months dual antiplatelet therapy in patients with acute coronary syndrome treated with the COMBO dual therapy stent: 2-years follow-up results of the REDUCE trial. J. Thromb. Thrombolysis. 2021;52:797–807. doi: 10.1007/s11239-021-02439-x. PubMed DOI

Silverio A., Di Maio M., Citro R., Esposito L., Iuliano G., Bellino M., Baldi C., De Luca G., Ciccarelli M., Vecchione C., et al. Cardiovascular risk factors and mortality in hospitalized patients with COVID-19: Systematic review and meta-analysis of 45 studies and 18,300 patients. BMC Cardiovasc. Disord. 2021;21:23. doi: 10.1186/s12872-020-01816-3. PubMed DOI PMC

Gelman A., Hill J. Data Analysis Using Regression and Multilevel/Hierarchical Models. Cambridge University Press; New York, NY, USA: 2007.

De Luca G., Suryapranata H., Dambrink J.H., Ottervanger J.P., van ‘t Hof A.W., Zijlstra F., Hoorntje J.C., Gosselink A.T., de Boer M.J. Sex-related differences in outcome after ST-segment elevation myocardial infarction treated by primary angioplasty: Data from the Zwolle Myocardial Infarction study. Am. Heart J. 2004;148:852–856. doi: 10.1016/j.ahj.2004.05.018. PubMed DOI

Paradossi U., Taglieri N., Massarelli G., Palmieri C., De Caterina A.R., Bruno A.G., Taddei A., Nardi E., Ghetti G., Palmerini T., et al. Female gender and mortality in ST-segment-elevation myocardial infarction treated with primary PCI. J. Cardiovasc. Med. 2022;23:234–241. doi: 10.2459/JCM.0000000000001300. PubMed DOI

De Luca G., Parodi G., Sciagrà R., Bellandi B., Verdoia M., Vergara R., Migliorini A., Valenti R., Antoniucci D. Relation of gender to infarct size in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty. Am. J. Cardiol. 2013;111:936–940. doi: 10.1016/j.amjcard.2012.12.011. PubMed DOI

De Luca G., Gibson C.M., Gyöngyösi M., Zeymer U., Dudek D., Arntz H.R., Bellandi F., Maioli M., Noc M., Zorman S., et al. Gender-related differences in outcome after ST-segment elevation myocardial infarction treated by primary angioplasty and glycoprotein IIb-IIIa inhibitors: Insights from the EGYPT cooperation. J. Thromb. Thrombolysis. 2010;30:342–346. doi: 10.1007/s11239-010-0451-y. PubMed DOI

De Luca G., Verdoia M., Dirksen M.T., Spaulding C., Kelbæk H., Schalij M., Thuesen L., Hoeven Bv Vink M.A., Kaiser C., Musto C., et al. Gender-related differences in outcome after BMS or DES implantation in patients with ST-segment elevation myocardial infarction treated by primary angioplasty: Insights from the DESERT cooperation. Atherosclerosis. 2013;230:3056. doi: 10.1016/j.atherosclerosis.2013.05.024. PubMed DOI

Chew N.W., Sia C.H., Wee H.L., Benedict L.J., Rastogi S., Kojodjojo P., Chor W.P.D., Leong B.S., Koh B.C., Tam H., et al. Impact of the COVID-19 Pandemic on Door-to-Balloon Time for Primary Percutaneous Coronary Intervention–Results From the Singapore Western STEMI Network. Circ. J. 2021;85:139–149. doi: 10.1253/circj.CJ-20-0800. PubMed DOI

Xiang D., Xiang X., Zhang W., Yi S., Zhang J., Gu X., Xu Y., Huang K., Su X., Yu B., et al. Management and Outcomes of Patients With STEMI During the COVID-19 Pandemic in China. J. Am. Coll. Cardiol. 2020;76:1318–1324. doi: 10.1016/j.jacc.2020.06.039. PubMed DOI PMC

De Luca G., Cercek M., Jensen L.O., Vavlukis M., Calmac L., Johnson T., Roura IFerrer G., Ganyukov V., Wojakowski W., von Birgelen C., et al. Impact of COVID-19 pandemic and diabetes on mechanical reperfusion in patients with STEMI: Insights from the ISACS STEMI COVID 19 Registry. Cardiovasc. Diabetol. 2020;19:215. doi: 10.1186/s12933-020-01196-0. PubMed DOI PMC

Rangé G., Hakim R., Beygui F., Angoulvant D., Marcollet P., Godin M., Deballon R., Bonnet P., Fichaux O., Barbey C., et al. Incidence, delays, and outcomes of STEMI during COVID-19 outbreak: Analysis from the France PCI registry. J. Am. Coll. Emerg. Physicians Open. 2020;1:1168–1176. doi: 10.1002/emp2.12325. PubMed DOI PMC

Meisel S.R., Tal O., Kobo O., Saada M., Nashed H., Fanne R.A., Alcalai R., Amsalem N., Levi Y., Mohsen J., et al. Impact of the Admission Pathway on the Gender-Related Mortality of Patients With ST-Elevation Myocardial Infarction. Am. J. Cardiol. 2022;166:9–17. doi: 10.1016/j.amjcard.2021.11.025. PubMed DOI

Verdoia M., Viglione F., Boggio A., Stefani D., Panarotto N., Malabaila A., Rolla R., Soldà P.L., De Luca G. Novara Atherosclerosis Study Group (NAS). Vitamin D deficiency is associated with impaired reperfusion in STEMI patients undergoing primary percutaneous coronary intervention. Vasc. Pharmacol. 2021;140:106897. doi: 10.1016/j.vph.2021.106897. PubMed DOI

Mo P., Xing Y., Xiao Y., Deng L., Zhao Q., Wang H., Xiong Y., Cheng Z., Gao S., Liang K., et al. Clinical characteristics of refractory COVID-19 pneumonia in Wuhan, China. Clin. Infect. Dis. 2021;73:e4208–e4213. doi: 10.1093/cid/ciaa270. PubMed DOI PMC

Gebhard C., Regitz-Zagrosek V., Neuhauser H.K., Morgan R., Klein S.L. Impact of sex and gender on COVID-19 outcomes in Europe. Biol. Sex. Differ. 2020;11:29. doi: 10.1186/s13293-020-00304-9. PubMed DOI PMC

Galloway J.B., Norton S., Barker R.D., Brookes A., Carey I., Clarke B.D., Jina R., Reid C., Russell M.D., Sneep R., et al. A clinical risk score to identify patients with COVID-19 at high risk of critical care admission or death: An observational cohort study. J. Infect. 2020;81:282–288. doi: 10.1016/j.jinf.2020.05.064. PubMed DOI PMC

Megiorni F., Pontecorvi P., Gerini G., Anastasiadou E., Marchese C., Ceccarelli S. Sex-Related Factors in Cardiovascular Complications Associated to COVID-19; Sex differences underlying preexisting cardiovascular disease and cardiovascular injury in COVID-19. Biomolecules. 2021;12:21. doi: 10.3390/biom12010021. PubMed DOI PMC

Fischer M., Baessler A., Schunkert H. Renin angiotensin system and gender differences in the cardiovascular system. Cardiovasc. Res. 2002;53:672–677. doi: 10.1016/S0008-6363(01)00479-5. PubMed DOI

Chappell M.C., Marshall A.C., Alzayadneh E.M., Shaltout H.A., Diz D.I. Update on the angiotensin converting enzyme 2-angiotensin (1-7)-Mas receptor axis: Fetal programing, sex differences, and intracellular pathways. Front. Endocrinol. 2014;4:201. doi: 10.3389/fendo.2013.00201. PubMed DOI PMC

De Rosa S., Spaccarotella C., Basso C., Calabrò M.P., Curcio A., Filardi P.P., Mancone M., Mercuro G., Muscoli S., Nodari S., et al. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era. Società Italiana di Cardiologia and the CCU Academy investigators group. Eur. Heart J. 2020;41:2083–2088. doi: 10.1093/eurheartj/ehaa409. PubMed DOI PMC

Barbero U., Moncalvo C., Trabattoni D., Pavani M., Amoroso G.R., Bocchino P.P., Giachet A.T., Saglietto A., Monticone S., Secco G.G., et al. Gender differences in acute coronary syndromes patterns during the COVID-19 outbreak. Am. J. Cardiovasc. Dis. 2020;10:506–513. PubMed PMC

Huynh J., Barmano N., Karlsson J.E., Stomby A. Sex and age differences in the incidence of acute myocardial infarction during the COVID-19 pandemic in a Swedish health-care region without lockdown: A retrospective cohort study. Lancet. 2021;2:e283–e289. doi: 10.1016/S2666-7568(21)00085-4. PubMed DOI