{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T03:17:19Z","timestamp":1783480639861,"version":"3.55.0"},"reference-count":62,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background. Despite technological innovations and improvements in stents and devices, sex-related discrepancies are still reported in the outcomes after ST-segment elevation myocardial infarction (STEMI), depending on biological and sex-specific pathophysiological differences, which have not been completely understood. The aim of the present study was to provide real-world data on the prognostic role of sex among patients with STEMI, enclosed into a recent up-to-date international registry. Methods. The ISACS-STEMI COVID-19 is a large-scale retrospective registry, including STEMI patients treated with mechanical reperfusion between 1 March and 30 June, 2019 and 2020. Patients, treated in 109 centers across Europe, Latin America, Southeast Asia, and North Africa, were grouped according to sex. Primary endpoint: In-hospital mortality; secondary endpoints: Time delay, 30-day mortality, and postprocedural Thrombolysis In Myocardial Infarction (TIMI) 3 flow. Results. We included 16,083 patients, 24.3% females (54.3% hospitalized in 2019, 45.7% in 2020). Women with STEMI were older, more often diabetic and hypertensive (p &lt; 0.001), with a higher prevalence of hypercholesterolemia (p = 0.02), longer ischemia time (p = 0.01), ambulance referral (p = 0.03) and cardiogenic shock at presentation (p = 0.05), but less frequently smokers, with a previous cardiovascular event (p &lt; 0.001) or anterior STEMI (p = 0.03) as compared to males. Preprocedural TIMI 0 flow, multivessel disease, need for thrombectomy (p &lt; 0.001 and p = 0.001, respectively), use of Glycoprotein IIbIIIa inhibitors or cangrelor, radial access and implantation of drug-eluting stents (p &lt; 0.001, p &lt; 0.001 and p = 0.001, respectively) were also more common in men. Impaired postprocedural epicardial reperfusion (TIMI flow 0\u20132) was observed more frequently in females as compared to males (10% vs. 7.2%; adjusted OR [95% CI] = 1.30 [1.13\u20131.49], p = 0.01). In-hospital mortality was 5.8%, significantly higher among women (8.3% vs. 5%, p &lt; 0.001, adjusted HR [95% CI] = 1.26 [1.06\u20131.5], p = 0.01). Similar data were observed for 30-day mortality (10.3% vs. 6.2%, p &lt; 0.001, adjusted HR [95% CI] = 1.22 [1.06\u20131.38], p = 0.007). Conclusions. Among STEMI patients being treated with the most updated standard of care for primary percutaneous coronary intervention, female sex is still associated with higher complexity and impaired prognosis, displaying suboptimal epicardial reperfusion and increased in-hospital and 30-day mortality.<\/jats:p>","DOI":"10.3390\/jcm15103560","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T09:03:37Z","timestamp":1778144617000},"page":"3560","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Persisting Sex Discrepancies in Short-Term Outcomes of Patients with ST-Segment Myocardial Infarction: Results of the ISACS-STEMI COVID-19 Registry"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6031-2899","authenticated-orcid":false,"given":"Giuseppe","family":"De Luca","sequence":"first","affiliation":[{"name":"Division of Cardiology, AOU \u201cPoliclinico G. Martino\u201d, Department of Clinical and Experimental Medicine, University of Messina, 98121 Messina, Italy"},{"name":"Division of Cardiology, IRCSS Galeazzi-Sant\u2019Ambrogio Hospital, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0703-1331","authenticated-orcid":false,"given":"Stephane","family":"Manzo-Silberman","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Piti\u00e9-Salp\u00eatri\u00e8re Hospital, Institute of Cardiology, ACTION Study Group, Sorbonne University, 75005 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7217-4961","authenticated-orcid":false,"given":"Filippo","family":"Zilio","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Ospedale Santa Chiara, 38122 Trento, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6806-9042","authenticated-orcid":false,"given":"Magdy","family":"Algowhary","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Assiut University Heart Hospital, Assiut University, Assiut 71524, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berat","family":"Uguz","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Bursa City Hospital, 16000 Bursa, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2734-2284","authenticated-orcid":false,"given":"Dinaldo C.","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Pronto de Socorro Cardiologico Prof. Luis Tavares, Centro PROCAPE, Federal University of Pernambuco, Recife 50670-901, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9704-7678","authenticated-orcid":false,"given":"Vladimir","family":"Ganyukov","sequence":"additional","affiliation":[{"name":"Department of Heart and Vascular Surgery, State Research Institute for Complex Issues of Cardiovascular Diseases, 650000 Kemerovo, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zan","family":"Zimbakov","sequence":"additional","affiliation":[{"name":"University Clinic for Cardiology, Medical Faculty, Ss\u2019 Cyril and Methodius University, 1000 Skopje, North Macedonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6193-0349","authenticated-orcid":false,"given":"Miha","family":"Cercek","sequence":"additional","affiliation":[{"name":"Centre for Intensive Internal Medicine, University Medical Centre, 1000 Ljubljana, 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