Gender Differences in Admissions and In-Hospital Outcomes of Patients With Acute Coronary Syndromes During the
Leonard Simoni1, Ilir Alimehmeti2, Astrit Ceka1
1Cardiovascular Disease, University Hospital Center Mother Teresa, Tirana, ALB.
Insights
During the COVID-19 pandemic, acute coronary syndrome (ACS) hospitalizations decreased similarly for men and women. However, male ACS mortality significantly increased, narrowing the gender gap.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- The coronavirus disease 2019 (COVID-19) pandemic saw a decrease in acute coronary syndrome (ACS) incidence.
- Limited research exists on gender-specific impacts of pandemics on ACS admissions and outcomes.
Purpose of the Study:
- To investigate the effect of the COVID-19 pandemic on male and female hospitalizations for ACS.
- To analyze in-hospital outcomes and mortality differences between genders during the pandemic.
Main Methods:
- A retrospective, single-center study compared ACS hospitalizations during the COVID-19 lockdown (March-April 2020) with the same period in 2019.
- Data were analyzed for all ACS cases, including ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA).
- Incidence rate ratios (IRR) and risk ratios (RR) were calculated to assess hospitalization rates and mortality.
Main Results:
- ACS hospitalizations decreased significantly for both males and females during the pandemic (IRR 0.58).
- STEMI admissions notably decreased in females (IRR 0.59), but not significantly in males (IRR 0.76). Unstable angina admissions decreased in both genders.
- Overall ACS mortality increased during the pandemic (7.4% vs 3.4%), with a significant rise in males (RR 3.02) but not females (RR 1.20).
Conclusions:
- ACS admissions declined similarly in both genders during the COVID-19 pandemic, with a more pronounced reduction in female STEMI cases.
- A significant increase in overall ACS mortality was observed, primarily driven by a substantial rise in male mortality.
- Further research is needed to elucidate the reasons behind the increased male mortality during the pandemic.
Abstract:
Background The incidence of acute coronary syndromes (ACS) decreased during the coronavirus disease 2019 (COVID-19) pandemic. Few studies have investigated gender differences in ACS admissions and outcomes during pandemics and have presented divergent results. This study aimed to investigate the effect of the COVID-19 pandemic on male and female hospitalizations and in-hospital outcomes in patients presenting with ACS. Methodology We designed a retrograde, single-center trial gathering data for ACS hospitalizations during the lockdown (March 9, 2020, to April 30, 2020) compared with the same timeframe of 2019. ACS hospitalizations were subgrouped as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA). We calculated the incidence rate ratio (IRR) to compare all-ACS and subgroups for male and female hospitalizations and the risk ratio (RR) to compare overall male/female mortality. Results This study included 321 ACS patients (238 males, 83 females) during the COVID-19 lockdown and 550 patients (400 males, 150 females) during 2019. The IRRs of all-ACS/males/females were significantly lower during the COVID-19 period at 0.58 (95% confidence interval (CI) = 0.44-0.76), 0.59 (95% CI = 0.43-0.75), and 0.55 (95% CI = 0.37-0.74), respectively. The IRR for STEMI was significantly lower among females (0.59 (95% CI = 0.39-0.89)), but not among males (0.76 (95% CI = 0.55-1.08)) The IRR for NSTEMI was not significantly lower, meanwhile it was significantly lower for UA among both males and females. The overall ACS mortality increased during the COVID-19 period (7.4% vs. 3.4%; RR = 2.16 (95% CI = 1.20-3.89)). Important increase was found in males (7.45% vs. 2.5%; RR = 3.02 (95% CI = 1.42-6.44)), but not in females (7.2% vs. 6%; RR = 1.20 (95% CI = 0.44-3.27). Conclusions The admissions of ACS reduced similarly in males and females during the COVID-19 pandemic. The admissions of STEMI reduced predominantly in females. We identified a substantial increase in the overall ACS mortality, but predominantly in males, reducing the differences between males and females. Further studies are necessary to better understand the increase in male mortality during the pandemic.
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