新冠疫情对ST段抬高型心肌梗死机械再灌注及30天死亡率影响的性别差异：ISACS-STEMI COVID-19注册研究结果
Gender Difference in the Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI: Results of the ISACS-STEMI COVID-19 Registry.
作者信息
De Luca Giuseppe, Manzo-Silberman Stephane, Algowhary Magdy, Uguz Berat, Oliveira Dinaldo C, Ganyukov Vladimir, Busljetik Oliver, Cercek Miha, Okkels Lisette, Loh Poay Huan, Calmac Lucian, Ferrer Gerard Roura I, Quadros Alexandre, Milewski Marek, Scotto di Uccio Fortunato, von Birgelen Clemens, Versaci Francesco, Ten Berg Jurrien, Casella Gianni, Wong Sung Lung Aaron, Kala Petr, Díez Gil José Luis, Carrillo Xavier, Dirksen Maurits, Becerra Victor, Lee Michael Kang-Yin, Juzar Dafsah Arifa, de Moura Joaquim Rodrigo, Paladino Roberto, Milicic Davor, Davlouros Periklis, Bakraceski Nikola, Zilio Filippo, Donazzan Luca, Kraaijeveld Adriaan, Galasso Gennaro, Arpad Lux, Marinucci Lucia, Guiducci Vincenzo, Menichelli Maurizio, Scoccia Alessandra, Yamac Aylin Hatice, Ugur Mert Kadir, Flores Rios Xacobe, Kovarnik Tomas, Kidawa Michal, Moreu Josè, Flavien Vincent, Fabris Enrico, Martínez-Luengas Iñigo Lozano, Boccalatte Marco, Ojeda Francisco Bosa, Arellano-Serrano Carlos, Caiazzo Gianluca, Cirrincione Giuseppe, Kao Hsien-Li, Forés Juan Sanchis, Vignali Luigi, Pereira Helder, Ordoñez Santiago, Arat Özkan Alev, Scheller Bruno, Lehtola Heidi, Teles Rui, Mantis Christos, Antti Ylitalo, Brum Silveira João António, Zoni Cesar Rodrigo, Bessonov Ivan, Uccello Giuseppe, Kochiadakis George, Alexopulos Dimitrios, Uribe Carlos E, Kanakakis John, Faurie Benjamin, Gabrielli Gabriele, Barrios Alejandro Gutierrez, Bachini Juan Pablo, Rocha Alex, Tam Frankie C C, Rodriguez Alfredo, Lukito Antonia Anna, Saint-Joy Veauthyelau, Pessah Gustavo, Tuccillo Andrea, Ielasi Alfonso, Cortese Giuliana, Parodi Guido, Bouraghda Mohamed Abed, Moura Marcia, Kedhi Elvin, Lamelas Pablo, Suryapranata Harry, Nardin Matteo, Verdoia Monica
机构信息
Division of Cardiology, AOU "Policlinico G. Martino", Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy.
Division of Cardiology, Nuovo Galeazzi-Sant'Ambrogio Hospital, 20161 Milan, Italy.
出版信息
J Clin Med. 2023 Jan 23;12(3):896. doi: 10.3390/jcm12030896.
BACKGROUND
Several reports have demonstrated the impact of the COVID-19 pandemic on the management and outcome of patients with ST-segment elevation myocardial infarction (STEMI). The aim of the current analysis is to investigate the potential gender difference in the effects of the COVID-19 pandemic on mechanical reperfusion and 30-day mortality for STEMI patients within the ISACS-STEMI COVID-19 Registry.
METHODS
This retrospective multicenter registry was performed in high-volume primary percutaneous coronary intervention (PPCI) centers on four continents and included STEMI patients undergoing PPCIs in March-June 2019 and 2020. Patients were divided according to gender. The main outcomes were the incidence and timing of the PPCI, (ischemia time ≥ 12 h and door-to-balloon ≥ 30 min) and in-hospital or 30-day mortality.
RESULTS
We included 16683 STEMI patients undergoing PPCIs in 109 centers. In 2020 during the pandemic, there was a significant reduction in PPCIs compared to 2019 (IRR 0.843 (95% CI: 0.825-0.861, < 0.0001). We did not find a significant gender difference in the effects of the COVID-19 pandemic on the numbers of STEMI patients, which were similarly reduced from 2019 to 2020 in both groups, or in the mortality rates. Compared to prepandemia, 30-day mortality was significantly higher during the pandemic period among female (12.1% vs. 8.7%; adjusted HR [95% CI] = 1.66 [1.31-2.11], < 0.001) but not male patients (5.8% vs. 6.7%; adjusted HR [95% CI] = 1.14 [0.96-1.34], = 0.12).
CONCLUSIONS
The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a 16% reduction in PPCI procedures similarly observed in both genders. Furthermore, we observed significantly increased in-hospital and 30-day mortality rates during the pandemic only among females.
背景
多项报告显示了新型冠状病毒肺炎（COVID-19）大流行对ST段抬高型心肌梗死（STEMI）患者管理及预后的影响。本分析的目的是在ISACS-STEMI COVID-19注册研究中，调查COVID-19大流行对STEMI患者机械再灌注及30天死亡率影响方面潜在的性别差异。
方法
这项回顾性多中心注册研究在四大洲的高容量直接经皮冠状动脉介入治疗（PPCI）中心开展，纳入了2019年3月至6月以及2020年接受PPCI的STEMI患者。患者按性别分组。主要结局为PPCI的发生率及时间（缺血时间≥12小时且门球时间≥30分钟）以及住院期间或30天死亡率。
结果
我们纳入了109个中心的16683例接受PPCI的STEMI患者。在2020年大流行期间，与2019年相比，PPCI显著减少（发病率比值比0.843（95%置信区间：0.825 - 0.861，P < 0.0001）。我们未发现COVID-19大流行对STEMI患者数量的影响存在显著性别差异，两组患者数量从2019年到2020年均同样减少，在死亡率方面也无显著性别差异。与大流行前相比，大流行期间女性30天死亡率显著更高（12.1%对8.7%；调整后风险比[95%置信区间]=1.66[1.31 - 2.11]，P < 0.001），而男性患者则不然（5.8%对6.7%；调整后风险比[95%置信区间]=1.14[0.96 - 1.34]，P = 0.12）。
结论
COVID-19大流行对STEMI患者的治疗产生了重大影响，两性的PPCI手术均同样减少了16%。此外，我们观察到仅在大流行期间女性的住院及30天死亡率显著增加。
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