Sex Differences in Clinical Characteristics, Management Strategies, and Outcomes of STEMI With COVID-19: NACMI
Odayme Quesada1,2, Logan Van Hon3, Mehmet Yildiz2
1Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio.
Insights
This study found that while women with ST-segment elevation myocardial infarction (STEMI) and COVID-19 were older and had more comorbidities, in-hospital mortality was similar between sexes. STEMI patients with COVID-19 showed no significant sex difference in mortality.
Area of Science:
- Cardiology
- Infectious Diseases
- Sex Differences in Medicine
Background:
- Women historically experience worse outcomes for ST-segment elevation myocardial infarction (STEMI) compared to men.
- COVID-19 infection is known to increase mortality risk in STEMI patients.
- Previous research has not examined sex-specific outcomes in STEMI patients with concomitant COVID-19.
Purpose of the Study:
- To compare sex differences in clinical characteristics, presentation, management, and in-hospital mortality among STEMI patients with COVID-19.
- To investigate the impact of COVID-19 on sex disparities in STEMI outcomes.
Main Methods:
- Utilized data from the North American COVID-19 STEMI registry, a prospective, multicenter registry.
- Compared clinical characteristics, presentation, management strategies, and in-hospital mortality between men and women with STEMI and COVID-19.
Main Results:
- Out of 585 patients, 154 (26.3%) were women. Women were older, with higher rates of diabetes and stroke/transient ischemic attack.
- Women more frequently presented with dyspnea and had STEMI without an identified culprit lesion (33% vs 18%) compared to men.
- In-hospital mortality was 33% for women and 27% for men (P = .22), with no statistically significant difference.
Conclusions:
- In-hospital mortality for STEMI patients with COVID-19 was approximately 30% and similar for both men and women.
- A lack of identifiable culprit lesion was more common in women (33%) than men (18%) with COVID-19 associated STEMI.
- Further research is needed to explore underlying etiologies and fully understand sex differences in COVID-19's impact on STEMI outcomes.
Background:
Women with ST-segment elevation myocardial infarction (STEMI) had worse outcomes than men prior to the COVID-19 pandemic. Although concomitant COVID-19 infection increases mortality risk in STEMI patients, no studies have evaluated sex differences in this context.
Methods:
The North American COVID-19 STEMI registry is a prospective, multicenter registry of hospitalized STEMI patients with COVID-19 infection. We compared sex differences in clinical characteristics, presentation, management strategies, and in-hospital mortality.
Results:
Among 585 patients with STEMI and COVID-19 infection, 154 (26.3%) were women. Compared to men, women were significantly older, had a higher prevalence of diabetes and stroke/transient ischemic attack, and were more likely to be on statins on presentation. Men more frequently presented with chest pain, whereas women presented with dyspnea. Women more often had STEMI without an identified culprit lesion than men (33% vs 18%, P < .001). The use of percutaneous coronary intervention was significantly higher in men, whereas medical therapy was higher in women. In-hospital mortality was 33% for women and 27% for men (P = .22).
Conclusions:
In patients presenting with STEMI in the context of COVID-19, the in-hospital mortality rate was 30% and similar for men and women. Lack of an identifiable culprit lesion was common in the setting of COVID-19 for both sexes but more likely in women (1/3 of women vs 1/5 of men). Evaluation of specific underlying etiologies is underway to better define the full impact of COVID-19 on STEMI outcomes and better understand the observed sex differences.
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