Abstract Background The SARS-CoV-2 outbreak has led to radical transformation in social, economic, and healthcare systems. This may lead to profound indirect consequences on clinical presentation and management of patients with ST-segment–elevation myocardial infarction. Objectives The objective of this study was to describe the characteristics, management, and outcomes of patients admitted with acute myocardial infarction with ST-segment elevation (STEMI), in two tertiary reference hospitals during the SARS-CoV-2 outbreak and compare them with patients admitted in the previous year. Methods We analyzed data from a multicenter STEMI registry from reference centers in the South Region of Brazil from March 2019 to May 2021. The beginning of the COVID-19 outbreak was considered to be March 2020 and compared to the same period in 2019. Only patients with STEMI submitted to primary percutaneous coronary intervention (PCI) were included in the analysis. Mortality rates were compared with chi-square test. All hypothesis tests had a two-sided significance level of 5%. Results A total of 1169 patients admitted with STEMI were enrolled in our registry, 635 of whom were admitted during the pandemic period. The mean age of our sample was 61.6 (± 12.4) years, and 66.7% of patients were male. Pain-to-door time and door-to-balloon time were longer during the pandemic period. However, there was no difference in mortality rates or major adverse cardiovascular outcomes (MACE). Conclusions We observed a stable incidence of STEMI cases in our registry during the SARS-CoV-2 outbreak with higher pain-to-door time and door-to-balloon time, without any influence on mortality rates however. SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- social economic systems STsegment–elevation STsegmentelevation ST segment–elevation segment characteristics STsegment STEMI, , (STEMI) year 201 2021 COVID19 COVID 19 COVID-1 202 PCI (PCI analysis chisquare chi square test twosided sided 5 5% 116 63 616 61 6 61. ± ( 12.4 124 12 4 years 667 66 7 66.7 male Paintodoor Pain door doortoballoon balloon However MACE. MACE . (MACE) paintodoor pain however SARS-CoV segmentelevation (STEMI 20 COVID1 1 COVID- 11 12. 66. (MACE

Resumo Fundamento Vários estudos têm mostrado que as mulheres não recebem tratamento adequado e apresentam piores desfechos após infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST). Por isso, é necessário investigar questões relacionadas ao gênero para melhor lidar com esse problema no Brasil. Objetivo Determinar se existe associação entre o sexo feminino e eventos adversos em uma coorte contemporânea de pacientes com IAMCSST submetidos à intervenção coronária percutânea primária (ICPp). Métodos Este foi um estudo prospectivo do tipo coorte de pacientes com IAMCSST submetidos à ICPp em um hospital universitário terciário entre março de 2011 e dezembro de 2021. Os pacientes foram categorizados em grupos de acordo com o sexo ao nascimento. O primeiro desfecho clínico foi ECAM em longo prazo. Os pacientes foram acompanhados por um período máximo de cinco anos. Um nível de significância bilateral de 0,05 foi aplicado em todos os testes de hipóteses. Resultados Entre os 1457 pacientes internados por IAMCSST no período do estudo, 1362 foram incluídos e 468 (34,4%) eram do sexo feminino. As mulheres apresentaram maior prevalência de hipertensão (73% vs. 60%, p<0,001), diabetes (32% vs. 25%, p=0,003) e classe Killip 3-4 na internação (17% vs. 12%, p=0,01); o escore de risco TIMI foi maior nas mulheres [4 (2, 6) vs. 3 (2, 5), p<0.001]. A mortalidade hospitalar não foi diferente entre os grupos (12,8% vs. 10,5%; p=0,20). Os ECAMs foram numericamente maiores nas mulheres que nos homens tanto durante a internação (16,0% vs. 12,6%, p=0,085) como em longo prazo (28,7% vs. 24,4%, p=0,089), com significância limítrofe. Após a análise multivariada, o sexo feminino não foi associado a ECAMs (HR = 1,14; IC95% 0,86 – 1,51; p = 0,36). Conclusão Em uma coorte prospectiva contemporânea de pacientes com IAMCSST submetidos à ICPp, pacientes do sexo feminino apresentaram idade mais avançada e mais comorbidades no basal que os pacientes do sexo masculino, mas não houve diferenças significativas entre os sexos quanto aos desfechos adversos no hospital ou em longo prazo. IAMCSST. . (IAMCSST) isso Brasil ICPp. (ICPp) 201 2021 nascimento anos 005 0 05 0,0 hipóteses 145 136 46 34,4% 344 34 4 (34,4% 73% 73 (73 vs 60 60% p<0,001, p0001 p<0,001 , 001 p<0,001) 32% 32 (32 25 25% p=0,003 p0003 003 3- 17% 17 (17 12 12% p=0,01 p001 01 p=0,01) [ 2, 2 (2 6 5, 5 5) p<0.001. p<0.001 p<0.001] 12,8% 128 8 (12,8 10,5% 105 10 p=0,20. p020 p=0,20 20 p=0,20) 16,0% 160 16 (16,0 126 12,6% p=0,085 p0085 085 28,7% 287 28 7 (28,7 244 24 24,4% p=0,089, p0089 p=0,089 089 p=0,089) limítrofe multivariada HR 1,14 114 1 14 IC95 IC 086 86 0,8 1,51 151 51 0,36. 036 0,36 36 0,36) masculino (IAMCSST (ICPp 202 00 0, 13 34,4 (34,4 (7 p000 p<0,00 (3 p=0,00 (1 p=0,0 p00 ( p<0.00 12,8 (12, 10,5 p02 p=0,2 16,0 (16, 12,6 p=0,08 p008 08 28,7 (28, 24,4 1,1 11 IC9 1,5 15 03 0,3 34, (34, p<0,0 p=0, p0 p<0.0 12, (12 10, 16, (16 28, (28 24, 1, (34 p<0, p=0 p<0. p<0 p= p<

Abstract Background Several studies have shown that women are usually undertreated and have worse outcomes after ST-segment elevation myocardial infarction (STEMI), hence the need to investigate questions related to sex in Brazil to better deal with the problem. Objective To determine whether female sex is still associated with adverse events in a contemporary cohort of patients with STEMI undergoing primary percutaneous coronary intervention (pPCI). Methods This was a prospective cohort study of STEMI patients submitted to pPCI in a tertiary university hospital between March 2011 and December 2021. Patients were categorized into groups based on their sex at birth. The primary clinical outcome was long-term MACCE. Patients were followed-up for up to five years. All hypothesis tests had a two-sided significance level of 0.05. Results Among 1457 patients admitted with STEMI in the study period, 1362 were included and 468 (34.4%) were women. Female patients had a higher prevalence of hypertension (73% vs. 60%, p <0.001), diabetes (32% vs. 25%, p=0.003) and Killip class 3-4 at hospital admission (17% vs. 12%, p=0.01); TIMI risk score was higher among women (4 [2, 6] vs. 3 [2, 5], p<0.001). In-hospital mortality was not different between groups (12.8% vs. 10.5%, p=0.20). In-hospital MACCE (16.0% vs. 12.6%, p=0.085) and long-term MACCE (28.7% vs. 24.4%, p=0.089) were numerically higher in women, with borderline significance. After multivariate analysis, female sex was not associated with MACCE (HR = 1.14; 95% CI 0.86 – 1.51; p = 0.36). Conclusion In a prospective cohort of STEMI patients submitted to pPCI, female patients were older and had more comorbidities at baseline, but no significant differences were found in terms of long-term adverse outcomes. STsegment ST segment STEMI, , (STEMI) problem pPCI. . (pPCI) 201 2021 birth longterm long term followedup followed years twosided two sided 005 0 05 0.05 145 period 136 46 34.4% 344 34 4 (34.4% 73% 73 (73 vs 60 60% <0.001, 0001 <0.001 001 <0.001) 32% 32 (32 25 25% p=0.003 p0003 003 3- 17% 17 (17 12 12% p=0.01 p001 01 p=0.01) ( 2, 2 [2 6 5, 5 5] p<0.001. p0001 p<0.001 p<0.001) Inhospital 12.8% 128 8 (12.8 105 10 10.5% p=0.20. p020 p=0.20 20 p=0.20) 16.0% 160 16 (16.0 126 12.6% p=0.085 p0085 085 28.7% 287 28 7 (28.7 244 24 24.4% p=0.089 p0089 089 analysis HR 1.14 114 1 14 95 086 86 0.8 1.51 151 51 0.36. 036 0.36 36 0.36) baseline (STEMI (pPCI 202 00 0.0 13 34.4 (34.4 (7 000 <0.00 (3 p=0.00 p000 (1 p=0.0 p00 [ p<0.00 12.8 (12. 10.5 p02 p=0.2 16.0 (16. 12.6 p=0.08 p008 08 28.7 (28. 24.4 1.1 11 9 0. 1.5 15 03 0.3 34. (34. <0.0 p=0. p0 p<0.0 12. (12 10. 16. (16 28. (28 24. 1. (34 <0. p=0 p<0. (2 <0 p= p<0 < p<