NACMI Registry Data Analysis Reveals Sex Differences in Clinical Characteristics and Treatment of Patients With STEMI and COVID-19

May 26, 2022—An analysis of the North American COVID-19 STEMI (NACMI) registry data found that clinical characteristics and treatment strategies for ST-segment elevation myocardial infarction (STEMI) patients with COVID-19 differ for female and male patients. However, in-hospital mortality rates remain high among both groups, compared to prepandemic rates.

The NACMI registry is a prospective, multicenter registry of hospitalized STEMI patients with COVID-19 infection at more than 60 medical centers across North America. A collaboration with the Society for Cardiovascular Angiography & Interventions (SCAI), the American College of Cardiology, and the Canadian Association of Interventional Cardiology, the registry was established in 2020 with the intention to define baseline characteristics, management strategies, and outcome data for COVID-19 patients presenting with STEMI.

The findings were presented as late-breaking clinical research at the SCAI 2022 Scientific Sessions held May 19-22 in Atlanta, Georgia. The findings were simultaneously published by Odayme Quesada, MD, et al in the Journal of the Society for Cardiovascular Angiography & Interventions (JSCAI).

According to the SCAI announcement, the authors of the analysis compared clinical characteristics, management strategies, and outcomes of male and female STEMI patients with COVID-19. Key findings from the NACMI registry analysis included:

• Among 585 patients with STEMI and COVID-19, 154 (26.3%) were female.
• Compared to male patients, female patients were significantly older and had higher rates of diabetes, stroke, and statin on admission.
• Female patients presented more often with STEMI without an identified culprit lesion.
• Male patients were more likely to present with chest pain whereas females presented with dyspnea, or labored breathing.
• Use of primary percutaneous coronary intervention was significantly higher in male patients, but use of medical therapy was higher in female patients.
• In-hospital mortality was similar for both groups at 33% for female patients and 27% for male patients (P = .217); prepandemic rates were previously below 5%.

Additionally, the findings in JSCAI revealed that there were no significant sex differences for in-hospital stroke, reinfarction, or composite endpoint. The authors also noted that further investigation is needed to better understand the sex differences in the underlying etiologies of STEMI.

Dr. Quesada, who is Medical Director at The Christ Hospital Women’s Heart Center in Cincinnati, Ohio, stated, “The significant increase in mortality among both men and women in this study highlights the need for continued research to better understand the long-term effects of COVID-19 on cardiovascular health. Our study also points to the lack of research and clear guidance on how to treat STEMI patients without an identified culprit lesion, many of which are women. We hope additional analysis of these patient characteristics will help further inform clinicians on best the treatment approach and ultimately improve patient outcomes.”