TY - JOUR
T1 - Persisting Sex Discrepancies in Short-Term Outcomes of Patients with ST-Segment Myocardial Infarction
T2 - Results of the ISACS-STEMI COVID-19 Registry
AU - De Luca, Giuseppe
AU - Manzo-Silberman, Stephane
AU - Zilio, Filippo
AU - Algowhary, Magdy
AU - Uguz, Berat
AU - Oliveira, Dinaldo C
AU - Ganyukov, Vladimir
AU - Zimbakov, Zan
AU - Cercek, Miha
AU - Jensen, Lisette Okkels
AU - Loh, Poay Huan
AU - Calmac, Lucian
AU - Ferrer, Gerard Roura I
AU - Quadros, Alexandre
AU - Milewski, Marek
AU - Scotto D'Uccio, Fortunato
AU - von Birgelen, Clemens
AU - Versaci, Francesco
AU - Ten Berg, Jurrien
AU - Casella, Gianni
AU - Lung, Aaron Wong Sung
AU - Kala, Petr
AU - Díez Gil, José Luis
AU - Carrillo, Xavier
AU - Dirksen, Maurits
AU - Becerra-Munoz, Victor M
AU - Lee, Michael Kang-Yin
AU - Juzar, Dafsah Arifa
AU - de Moura Joaquim, Rodrigo
AU - Paladino, Roberto
AU - Milicic, Davor
AU - Davlouros, Periklis
AU - Bakraceski, Nikola
AU - Donazzan, Luca
AU - Kraaijeveld, Adriaan
AU - Galasso, Gennaro
AU - Arpad, Lux
AU - Marinucci, Lucia
AU - Guiducci, Vincenzo
AU - Menichelli, Maurizio
AU - Scoccia, Alessandra
AU - Yamac, Aylin Hatice
AU - Ugur Mert, Kadir
AU - Flores Rios, Xacobe
AU - Kovarnik, Tomas
AU - Kidawa, Michal
AU - Moreu, Josè
AU - Flavien, Vincent
AU - Fabris, Enrico
AU - Martínez-Luengas, Iñigo Lozano
AU - Ojeda, Francisco Bosa
AU - Rodríguez-Sanchez, Robert
AU - Caiazzo, Gianluca
AU - Cirrincione, Giuseppe
AU - Kao, Hsien-Li
AU - Forés, Juan Sanchis
AU - Vignali, Luigi
AU - Pereira, Helder
AU - Ordoñez, Santiago
AU - Arat Özkan, Alev
AU - Scheller, Bruno
AU - Lehtola, Heidi
AU - Teles, Rui
AU - Mantis, Christos
AU - Antti, Ylitalo
AU - Brum Silveira, João António
AU - Zoni, Rodrigo
AU - Bessonov, Ivan
AU - Savonitto, Stefano
AU - Kochiadakis, George
AU - Alexopulos, Dimitrios
AU - Uribe, Carlos E
AU - Kanakakis, John
AU - Faurie, Benjamin
AU - Gabrielli, Gabriele
AU - Barrios, Alejandro Gutierrez
AU - Bachini, Juan Pablo
AU - Rocha, Alex
AU - Tam, Frankie Chor-Cheung
AU - Rodriguez, Alfredo
AU - Lukito, Antonia Anna
AU - Bellemain-Appaix, Anne
AU - Pessah, Gustavo
AU - Cortese, Giuliana
AU - Parodi, Guido
AU - Burgadha, Mohammed Abed
AU - Kedhi, Elvin
AU - Lamelas, Pablo
AU - Suryapranata, Harry
AU - Nardin, Matteo
AU - Verdoia, Monica
N1 - Publisher Copyright:
© 2026 by the authors.
PY - 2026/5/7
Y1 - 2026/5/7
N2 -
Background. 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.
Methods. 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.
Results. 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 (
p < 0.001), with a higher prevalence of hypercholesterolemia (
p = 0.02), longer ischemia time (
p = 0.01), ambulance referral (
p = 0.03) and cardiogenic shock at presentation (
p = 0.05), but less frequently smokers, with a previous cardiovascular event (
p < 0.001) or anterior STEMI (
p = 0.03) as compared to males. Preprocedural TIMI 0 flow, multivessel disease, need for thrombectomy (
p < 0.001 and
p = 0.001, respectively), use of Glycoprotein IIbIIIa inhibitors or cangrelor, radial access and implantation of drug-eluting stents (
p < 0.001,
p < 0.001 and
p = 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],
p = 0.01). In-hospital mortality was 5.8%, significantly higher among women (8.3% vs. 5%,
p < 0.001, adjusted HR [95% CI] = 1.26 [1.06-1.5],
p = 0.01). Similar data were observed for 30-day mortality (10.3% vs. 6.2%,
p < 0.001, adjusted HR [95% CI] = 1.22 [1.06-1.38],
p = 0.007).
Conclusions. 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.
AB -
Background. 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.
Methods. 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.
Results. 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 (
p < 0.001), with a higher prevalence of hypercholesterolemia (
p = 0.02), longer ischemia time (
p = 0.01), ambulance referral (
p = 0.03) and cardiogenic shock at presentation (
p = 0.05), but less frequently smokers, with a previous cardiovascular event (
p < 0.001) or anterior STEMI (
p = 0.03) as compared to males. Preprocedural TIMI 0 flow, multivessel disease, need for thrombectomy (
p < 0.001 and
p = 0.001, respectively), use of Glycoprotein IIbIIIa inhibitors or cangrelor, radial access and implantation of drug-eluting stents (
p < 0.001,
p < 0.001 and
p = 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],
p = 0.01). In-hospital mortality was 5.8%, significantly higher among women (8.3% vs. 5%,
p < 0.001, adjusted HR [95% CI] = 1.26 [1.06-1.5],
p = 0.01). Similar data were observed for 30-day mortality (10.3% vs. 6.2%,
p < 0.001, adjusted HR [95% CI] = 1.22 [1.06-1.38],
p = 0.007).
Conclusions. 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.
U2 - 10.3390/jcm15103560
DO - 10.3390/jcm15103560
M3 - Article
C2 - 42194522
SN - 2077-0383
VL - 15
JO - Journal of Clinical medicine
JF - Journal of Clinical medicine
IS - 10
M1 - 3560
ER -