Sex differences observed in diagnosis, treatment of STEMI, concomitant COVID-19
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ATLANTA — In the setting of concomitant STEMI and COVID-19, researchers identified several sex-based differences in STEMI diagnosis and treatment, a speaker reported.
Although fewer culprit lesions were identified among women compared with men, and women were less often treated with PCI, there no differences by sex in in-hospital mortality, according to data presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions.
“Prior to the COVID-19 pandemic, sex differences were well-described in STEMI patients with worse prognosis in women,” Odayme Quesada, MD, medical director at The Christ Hospital Women’s Heart Center in Cincinnati, said during a press conference. “We know that COVID-19 increases the risk of myocardial infarction by up to twofold, with both direct and indirect effects on the mortality risk, which is higher in COVID-19 patients. There’s been some data reporting worse prognosis in males with COVID-19 infection. However, there’s no data on sex differences of STEMI patients with concomitant COVID-19 infection to date. Therefore, our goal was to describe sex differences in clinical characteristics, management strategies and outcomes of STEMI patients with concomitant COVID-19 infection.”
Data were obtained using the NACMI registry. The researchers’ analysis included 64 sites across the U.S. and Canada.
The study was simultaneously published in the Journal of the Society for Cardiovascular Angiography & Interventions.
All 585 patients in this cohort were adults with ST elevation in at least two contiguous ECG leads or new-onset left bundle branch block; clinical evidence of ischemia; and a positive COVID-19 test during or 4 weeks before hospital presentation.
The primary endpoint was in-hospital mortality. Secondary endpoints included stroke, reinfarction and a composite of stroke reinfarction and mortality.
Women represented 26.3% of the total cohort and were on average older at presentation compared with men (P < .001).
Women more often had preexisting diabetes (53% vs. 41%; P = .01) and previous stroke/transient ischemic attack compared with men (14% vs. 7.4%; P = .02).
Upon arrival to the hospital, women were more likely to be on a statin (49% vs. 32%; P < .001) and present with dyspnea (56% vs. 45%; P = .016); however, men were more likely to present with chest pain (47% vs. 59%; P = .008).
Overall, approximately 18% of patients who presented with STEMI did not undergo angiography.
The culprit vessel was identified in 67% women compared with 82% of men (P < .001).
Men were more often treated with PCI (61% vs. 76%; P = .002) while women were more likely to receive medical therapy for STEMI (33% vs. 20%; P = .003).
Occurrence of in-hospital mortality (women, 33%; men, 27%; P = .217) and the composite secondary endpoint (women, 40%; men, 34%; P = .184) was high in both groups; however, researchers were unable to conclude any sex differences.
From this analysis, Quesada and colleagues derived the following relative risks associated with in-hospital mortality in concomitant STEMI and COVID-19 infection:
- age older than 66 years (RR = 1.62; 95% CI, 1.21-2.18);
- history of stroke/TIA (RR = 1.54; 95% CI, 1-2.28);
- pulmonary infiltrates on 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 sex-based differences in risk factors, presentation, underlying etiology of STEMI and treatment of patients with COVID-19 and STEMI. No identifiable culprit lesion on angiography was common in the setting of COVID-19 and STEMI for both sexes, but more likely in women,” Quesada said during the presentation. “Despite older age and higher comorbidities for women, in-hospital mortality was similar for men and women. At this time, we’re undergoing evaluation of specific underlying etiologies to better define the full impact of COVID-19 on STEMI outcomes and better understand the sex differences.”
Reference:
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Quesada O, et al. Featured Clinical Research: Part 1. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 19-22, 2022; Atlanta.
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