Gender Differences Observed in Diagnosis, Treatment of STEMI, Concomitant COVID-19

Source:

Quesada O, et al. Featured Clinical Research: Part 1. Presented at: Scientific Sessions of the Society for Cardiovascular Angiography and Interventions; May 19-22, 2022; Atlanta.


Disclosures: One author reports receiving institutional research grants from Abbott Vascular, Boston Scientific, Edwards Lifesciences, and Medtronic; consultant for the American College of Cardiology, Boston Scientific and Medtronic; and as a supervisor for Edwards Lifesciences. Quesada and the other authors report no relevant financial information.


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ATLANTA – In the setting of co-occurring STEMI and COVID-19, researchers have identified several sex-based differences in the diagnosis and treatment of STEMI, a speaker reported.

Although fewer culpable lesions were identified in women than in men, and women were treated with PCI less often, there were no gender differences in in-hospital mortality, according to data presented during the Scientific Sessions of the Society for Cardiovascular Angiography and Interventions.


Graphical representation of the data presented in the article
Data are from Quesada O, et al. Featured Clinical Research: Part 1. Presented at: Scientific Sessions of the Society for Cardiovascular Angiography and Interventions; May 19-22, 2022; Atlanta.


“Before the COVID-19 pandemic, gender differences were well described in STEMI patients with a worse prognosis in women,” Odayme Quesada, MD, medical director of Christ Hospital Women’s Heart Center in Cincinnati, said at a press conference. “We know that COVID-19 increases the risk of myocardial infarction up to two times, with both direct and indirect effects on mortality risk, which is higher in patients with COVID-19. There is some evidence of a worse prognosis in men infected with COVID-19. However, to date there are no data on gender differences in STEMI patients with co-infection with COVID-19. Therefore, our goal was to describe gender differences in clinical characteristics, management strategies, and outcomes of STEMI patients with co-infection with COVID-19.

Data were obtained using the NACMI registry. The researchers’ analysis included 64 sites across the United States and Canada.

The study was published simultaneously in the Society Journal for Cardiovascular angiography & Interventions.

The 585 patients in this cohort were all adults with ST-segment elevation in at least two contiguous ECG leads or new left bundle branch block; clinical signs of ischemia; and a positive COVID-19 test during or 4 weeks prior to hospital presentation.

The primary endpoint was in-hospital mortality. Secondary endpoints included stroke, reinfarction, and a composite of stroke recurrence and mortality.

Women represented 26.3% of the total cohort and were on average older at presentation than men (P

Women more often had pre-existing diabetes (53% versus 41%; P = 0.01) and history of stroke/transient ischemic attack compared to men (14% versus 7.4%; P = .02).

Upon arrival at the hospital, women were more likely to take a statin (49% vs. 32%; P P = 0.016); however, men were more likely to experience chest pain (47% vs. 59%; P = 0.008).

Overall, approximately 18% of patients with STEMI did not undergo angiography.

The causative vessel was identified in 67% of women versus 82% of men (P

Men were more often treated with PCI (61% versus 76%; P = 0.002) while women were more likely to receive medical treatment for STEMI (33% vs. 20%; P = 0.003).

Presence of hospital mortality (women, 33%; men, 27%; P = 0.217) and the composite secondary endpoint (women, 40%; men, 34%; P = 0.184) was high in both groups; however, the researchers could not conclude any difference between the sexes.

From this analysis, Quesada and colleagues derived the following relative risks associated with in-hospital mortality from co-infection with STEMI and COVID-19:

  • age greater than 66 (RR=1.62; 95% CI, 1.21-2.18);
  • history of stroke/TIA (RR=1.54; 95% CI, 1-2.28);
  • pulmonary infiltrates at presentation (RR=1.97; 95% CI, 1.48-2.64); and
  • pre-PCI cardiogenic shock (RR=2.35; 95% CI, 1.69-3.22).

“We show that there are important gender-based differences in risk factors, presentation, underlying STEMI etiology, and treatment of patients with COVID-19 and STEMI. No culpable lesions identifiable on angiography were common in COVID-19 and STEMI for both genders, but more likely in females,” Quesada said during the presentation. “Despite older age and higher comorbidities in women, hospital mortality was similar for men and women. Currently, we are evaluating specific underlying etiologies to better define the total impact of COVID-19 on STEMI outcomes and better understand gender differences.

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