Persisting Sex Discrepancies in Short-Term Outcomes of Patients with ST-Segment Myocardial Infarction: Results of the ISACS-STEMI COVID-19 Registry.
Journal
Journal of clinical medicine
Journal Volume
15
Journal Issue
10
Start Page
Article number 3560
ISSN
2077-0383
Date Issued
2026-05-07
Author(s)
De Luca, Giuseppe
Manzo-Silberman, Stephane
Zilio, Filippo
Algowhary, Magdy
Uguz, Berat
Oliveira, Dinaldo C
Ganyukov, Vladimir
Zimbakov, Zan
Cercek, Miha
Jensen, Lisette Okkels
Loh, Poay Huan
Calmac, Lucian
Ferrer, Gerard Roura I
Quadros, Alexandre
Milewski, Marek
Scotto D'Uccio, Fortunato
von Birgelen, Clemens
Versaci, Francesco
Ten Berg, Jurrien
Casella, Gianni
Lung, Aaron Wong Sung
Kala, Petr
Díez Gil, José Luis
Carrillo, Xavier
Dirksen, Maurits
Becerra-Munoz, Victor M
Lee, Michael Kang-Yin
Juzar, Dafsah Arifa
de Moura Joaquim, Rodrigo
Paladino, Roberto
Milicic, Davor
Davlouros, Periklis
Bakraceski, Nikola
Donazzan, Luca
Kraaijeveld, Adriaan
Galasso, Gennaro
Arpad, Lux
Marinucci, Lucia
Guiducci, Vincenzo
Menichelli, Maurizio
Scoccia, Alessandra
Yamac, Aylin Hatice
Ugur Mert, Kadir
Flores Rios, Xacobe
Kovarnik, Tomas
Kidawa, Michal
Moreu, Josè
Flavien, Vincent
Fabris, Enrico
Martínez-Luengas, Iñigo Lozano
Ojeda, Francisco Bosa
Rodríguez-Sanchez, Robert
Caiazzo, Gianluca
Cirrincione, Giuseppe
Forés, Juan Sanchis
Vignali, Luigi
Pereira, Helder
Ordoñez, Santiago
Arat Özkan, Alev
Scheller, Bruno
Lehtola, Heidi
Teles, Rui
Mantis, Christos
Antti, Ylitalo
Brum Silveira, João António
Zoni, Rodrigo
Bessonov, Ivan
Savonitto, Stefano
Kochiadakis, George
Alexopulos, Dimitrios
Uribe, Carlos E
Kanakakis, John
Faurie, Benjamin
Gabrielli, Gabriele
Barrios, Alejandro Gutierrez
Bachini, Juan Pablo
Rocha, Alex
Tam, Frankie Chor-Cheung
Rodriguez, Alfredo
Lukito, Antonia Anna
Bellemain-Appaix, Anne
Pessah, Gustavo
Cortese, Giuliana
Parodi, Guido
Burgadha, Mohammed Abed
Kedhi, Elvin
Lamelas, Pablo
Suryapranata, Harry
Nardin, Matteo
Verdoia, Monica
Abstract
. 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. . 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. . 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 ( < 0.001), with a higher prevalence of hypercholesterolemia ( = 0.02), longer ischemia time ( = 0.01), ambulance referral ( = 0.03) and cardiogenic shock at presentation ( = 0.05), but less frequently smokers, with a previous cardiovascular event ( < 0.001) or anterior STEMI ( = 0.03) as compared to males. Preprocedural TIMI 0 flow, multivessel disease, need for thrombectomy ( < 0.001 and = 0.001, respectively), use of Glycoprotein IIbIIIa inhibitors or cangrelor, radial access and implantation of drug-eluting stents ( < 0.001, < 0.001 and = 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], = 0.01). In-hospital mortality was 5.8%, significantly higher among women (8.3% vs. 5%, < 0.001, adjusted HR [95% CI] = 1.26 [1.06-1.5], = 0.01). Similar data were observed for 30-day mortality (10.3% vs. 6.2%, < 0.001, adjusted HR [95% CI] = 1.22 [1.06-1.38], = 0.007). . 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.
Subjects
ST-segment elevation myocardial infarction
outcomes
primary percutaneous coronary intervention
sex
Type
journal article