Simoni Leonard, Alimehmeti Ilir, Ceka Astrit, Gina Mirald, Tafaj Ermir, Dibra Alban, Goda Artan
Cardiovascular Disease, University Hospital Center Mother Teresa, Tirana, ALB.
Occupational Health, Faculty of Medicine, University of Medicine, Tirana, ALB.
Cureus. 2022 Mar 18;14(3):e23286. doi: 10.7759/cureus.23286. eCollection 2022 Mar.
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.
在2019年冠状病毒病（COVID-19）大流行期间，急性冠状动脉综合征（ACS）的发病率有所下降。很少有研究调查大流行期间ACS住院情况及预后的性别差异，且结果不一。本研究旨在调查COVID-19大流行对ACS患者男性和女性住院情况及住院期间预后的影响。
我们设计了一项回顾性单中心试验，收集2020年3月9日至4月30日封锁期间ACS住院数据，并与2019年同一时间段进行比较。ACS住院病例分为ST段抬高型心肌梗死（STEMI）、非ST段抬高型心肌梗死（NSTEMI）和不稳定型心绞痛（UA）。我们计算发病率比（IRR）以比较男性和女性全ACS及亚组的住院情况，计算风险比（RR）以比较总体男性/女性死亡率。
本研究纳入了COVID-19封锁期间的321例ACS患者（238例男性，83例女性）和2019年的550例患者（400例男性，150例女性）。COVID-19期间全ACS/男性/女性的IRR显著降低，分别为0.58（95%置信区间（CI）=0.44 - 0.76）、0.59（95%CI = 0.43 - 0.75）和0.55（95%CI = 0.37 - 0.74）。STEMI的IRR在女性中显著降低（0.59（95%CI = 0.39 - 0.89）），但在男性中未显著降低（0.76（95%CI = 0.55 - 1.08））。NSTEMI的IRR没有显著降低，同时UA在男性和女性中的IRR均显著降低。COVID-19期间总体ACS死亡率有所上升（7.4%对3.4%；RR = 2.16（95%CI = 1.20 - 3.89））。男性死亡率有显著上升（7.45%对2.5%；RR = 3.02（95%CI = 1.42 - 6.44）），但女性没有（7.2%对6%；RR = 1.20（95%CI = 0.44 - 3.27））。
在COVID-19大流行期间，男性和女性ACS住院人数均同样减少。STEMI住院人数主要在女性中减少。我们发现总体ACS死亡率大幅上升，但主要是男性，这缩小了男性和女性之间的差异。需要进一步研究以更好地理解大流行期间男性死亡率上升的情况。
