Introduction and objectives The COVID-19 outbreak has had an unclear impact on the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess changes in STEMI management during the COVID-19 outbreak. Methods Using a multicenter, nationwide, retrospective, observational registry of consecutive patients who were managed in 75 specific STEMI care centers in Spain, we compared patient and procedural characteristics and in-hospital outcomes in 2 different cohorts with 30-day follow-up according to whether the patients had been treated before or after COVID-19. Results Suspected STEMI patients treated in STEMI networks decreased by 27.6% and patients with confirmed STEMI fell from 1305 to 1009 (22.7%). There were no differences in reperfusion strategy (> 94% treated with primary percutaneous coronary intervention in both cohorts). Patients treated with primary percutaneous coronary intervention during the COVID-19 outbreak had a longer ischemic time (233 [150-375] vs 200 [140-332] minutes, P < .001) but showed no differences in the time from first medical contact to reperfusion. In-hospital mortality was higher during COVID-19 (7.5% vs 5.1%; unadjusted OR, 1.50; 95%CI, 1.07-2.11; P < .001); this association remained after adjustment for confounders (risk-adjusted OR, 1.88; 95%CI, 1.12-3.14; P = .017). In the 2020 cohort, there was a 6.3% incidence of confirmed SARS-CoV-2 infection during hospitalization. Conclusions The number of STEMI patients treated during the current COVID-19 outbreak fell vs the previous year and there was an increase in the median time from symptom onset to reperfusion and a significant 2-fold increase in the rate of in-hospital mortality. No changes in reperfusion strategy were detected, with primary percutaneous coronary intervention performed for the vast majority of patients. The co-existence of STEMI and SARS-CoV-2 infection was relatively infrequent.

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LaburpenaBihotzekoak edo miokardioko infartu akutuak (MIA) behar bezala artatzeko oinarrizkoa da sare egoki bat sortzea. Erlazio zuzena dago sareen eta MIAen hilgarritasun-tasaren artean. Ezer gutxi dakigu, ordea, sareek MIA jasaten duten emakumeengan duten eraginaz. EAEn sarea 2012an sortu zen, BIHOTZEZ. EAEn 2012ko apiriletik 2013ko urrira eta 2014ko apiriletik 2015ko urrira jazo diren MIAk aztertu dira artatzeko orduan gizon eta emakumeen artean diferentziarik dagoen ikusteko eta sarearen eragina aztertzeko. Horretarako aztertu dira hilgarritasun-tasa eta sarearen kalitatea neurtzen duten denborak: sintomak hasi eta lehen harreman medikorakoa (LHM), LHM eta lehentasunezko azaleko interbentzio koronariorakoa (LHM-LAIK) eta LHM eta fibrinolisirakoa (LHMfibrinolisia). 913 MIA jaso ziren, 234 emakume eta 639 gizon. Emakumeen batez besteko adina 10 urte zaharragoa zen. Adinaren arabera doitu ondoren, ez zen ezberdintasunik ageri bihotzekoen arrisku-faktoreen artean. Emakume gutxiagok jaso zuten tratamenduren bat (% 91,5 vs % 95,3; p=0,002), atzerapenak handiagoak izan ziren emakumeetan (LHM-LAIK 107 min vs 95 min; LHMfibrinolisia 35 min vs 30 min). Hilgarritasun-tasan ez zen ezberdintasunik ikusi. Sareak eragina izan zuen tratamenduaren kalitatea neurtzen duten denboretan, murrizketak emakumeengan nabarmenagoak izan zirelarik (LHM-LAIK 22 min; LHM-fibrinolisia 2,5 min). Emakumeen hilgarritasuntasa % 10etik % 6,4ra jaitsi zen, ez, ordea gizonezkoena (% 2,2 vs 2,2). Gizonekin alderatuta MIA jasaten duten emakumek aukera gutxiago dute tratamendu egokia behar den denboran jasotzeko. BIHOTZEZ sarearen eraginez tratamenduraino doazen denbora-tarteak eta heriotza-tasa nabarmen murriztu dira emakumeen artean.Gako-hitzak: STISKA, Sarea, Emakumeak, bihotzekoa, heriotza-tasa. Abstract According to the European Society of Cardiology guidelines, ST-segment elevation myocardial infarction (STEMI) networks are mandatory in order to

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