Impact of coronavirus disease 19 (COVID-19) pandemic on gender differences of acute coronary syndromes admissions and in-hospital outcomes

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background The incidence of acute coronary syndromes (ACS) decreased during the Coronavirus Disease 19 (COVID-19) pandemic. There are few studies regarding gender differences in ACS admissions and outcomes during the pandemic that presented divergent results. Purpose The impact of COVID-19 pandemic on male and female ACS admissions and in-hospital outcomes. Methods A retrograde single-center study was conducted, collecting data for ACS admissions from March 9th (first COVID-19 case) until April 30th2020, compared with the same period of 2019. ACS admissions were classified as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA). Incidence rate ratio (IRR) was used to compare all-ACS and subgroups admissions, and risk ratio (RR) to compare overall/male/female mortality. Results There were 321 ACS patients (238 males, 83 females) during the pandemic period and 550 patients (400 males, 150 females) during 2019. The IRR of all-ACS/males/females were significantly lower during COVID-19 period,respectively 0.58 (0.44-0.76), 0.59 (0.43-0.75) and 0.55 (0.37-0.74). The IRR for STEMI was significantly lower among females (0.59[0.39-0.89]), but not in males (0.76 [0.55-1.08]). The IRR for NSTEMI was lower but unsignificantly, meanwhile for UA it was significantly lower for both, males (0.40 [0.24-0.51]) and females (0.50 [0.33-0.84]). The overall ACS mortality was importantly increased during the COVID-19 period (7.4% vs. 3.4%) RR=2.16 (1.20-3.89). Significant increase was found in males (7.45% vs. 2.5%) RR=3.02 (1.42-6.44), but not in females (7.2% vs. 6%) RR=1.20 (0.44-3.27). Conclusions Admissions for ACS were reduced similarly in males and females during the COVID-19 pandemic. Main reductions were observed in UA group similarly in both genders and in STEMI predominantly in females. While we identified a substantial increase in the overall ACS mortality, significant increase was observed only in males reducing the differences between genders. Further studies are necessary for a better understanding of the increase in male mortality during this period.