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• The characteristics and outcome of SARS-CoV-2 positive STEMI patients undergoing PPCI are poorly characterized. • In this individual patient data meta-analysis, SARS-CoV-2 positivity is independently associated with impaired TIMI flow after PPCI and a significantly higher in-hospital mortality, especially in male patients. • SARS-CoV-2 positivity constitutes a high-risk STEMI phenotype; pharmacological and mechanical reperfusion treatments should be implemented to improve post-procedural coronary reperfusion and ultimately outcome in this patient population. The characteristics and outcome of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients with ST-Elevation Myocardial Infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) are still poorly known. The PANDEMIC study was an investigator-initiated, collaborative, individual patient data (IPD) meta-analysis of registry-based studies. MEDLINE, ScienceDirect, Web of Sciences, and SCOPUS were searched to identify all registry-based studies describing the characteristics and outcome of SARS-CoV-2-positive STEMI patients undergoing PPCI. The control group consisted of SARS-CoV-2-negative STEMI patients undergoing PPCI in the same time period from the ISACS-STEMI COVID 19 registry. The primary outcome was in-hospital mortality; the secondary outcome was postprocedural reperfusion assessed by TIMI flow. Of 8 registry-based studies identified, IPD were obtained from 6 studies including 941 SARS-CoV-2-positive patients; the control group included 2005 SARS-CoV-2-negative patients. SARS-CoV-2-positive patients showed a significantly higher in-hospital mortality (p < 0.001) and worse postprocedural TIMI flow (<3, p < 0.001) compared with SARS-CoV-2-negative subjects. The increased risk for SARS-CoV-2-positive patients was significantly higher in males compared to females for both the primary (p interaction = 0.001) and secondary outcome (p interaction = 0.023). In SARS-CoV-2-positive patients, age ≥ 75 years (OR = 5.72; 95%CI: 1.77–18.5), impaired postprocedural TIMI flow (OR = 11.72; 95%CI: 2.64–52.10), and cardiogenic shock at presentation (OR = 11.02; 95%CI: 2.84–42.80) were independent predictors of mortality. In STEMI patients undergoing PPCI, SARS-CoV-2 positivity is independently associated with impaired reperfusion and with a higher risk of in-hospital mortality, especially among male patients. Age ≥ 75 years, cardiogenic shock, and impaired postprocedural TIMI flow independently predict mortality in this high-risk population. [ABSTRACT FROM AUTHOR]