Dataset Information

Impact of COVID-19 Pandemic on Mechanical Reperfusion for Patients With STEMI.

ABSTRACT:

Background

The fear of contagion during the coronavirus disease-2019 (COVID-19) pandemic may have potentially refrained patients with ST-segment elevation myocardial infarction (STEMI) from accessing the emergency system, with subsequent impact on mortality.

Objectives

The ISACS-STEMI COVID-19 registry aims to estimate the true impact of the COVID-19 pandemic on the treatment and outcome of patients with STEMI treated by primary percutaneous coronary intervention (PPCI), with identification of "at-risk" patient cohorts for failure to present or delays to treatment.

Methods

This retrospective registry was performed in European high-volume PPCI centers and assessed patients with STEMI treated with PPPCI in March/April 2019 and 2020. Main outcomes are the incidences of PPCI, delayed treatment, and in-hospital mortality.

Results

A total of 6,609 patients underwent PPCI in 77 centers, located in 18 countries. In 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio: 0.811; 95% confidence interval: 0.78 to 0.84; p < 0.0001). The heterogeneity among centers was not related to the incidence of death due to COVID-19. A significant interaction was observed for patients with arterial hypertension, who were less frequently admitted in 2020 than in 2019. Furthermore, the pandemic was associated with a significant increase in door-to-balloon and total ischemia times, which may have contributed to the higher mortality during the pandemic.

Conclusions

The COVID-19 pandemic had significant impact on the treatment of patients with STEMI, with a 19% reduction in PPCI procedures, especially among patients suffering from hypertension, and a longer delay to treatment, which may have contributed to the increased mortality during the pandemic. (Primary Angioplasty for STEMI During COVID-19 Pandemic [ISACS-STEMI COVID-19] Registry; NCT04412655).

SUBMITTER: De Luca G

PROVIDER: S-EPMC7834750 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Publications

Impact of COVID-19 Pandemic on Mechanical Reperfusion for Patients With STEMI.

De Luca Giuseppe G Verdoia Monica M Cercek Miha M Jensen Lisette Okkels LO Vavlukis Marija M Calmac Lucian L Johnson Tom T Ferrer Gerard Rourai GR Ganyukov Vladimir V Wojakowski Wojtek W Kinnaird Tim T van Birgelen Clemens C Cottin Yves Y IJsselmuiden Alexander A Tuccillo Bernardo B Versaci Francesco F Royaards Kees-Jan KJ Berg Jurrien Ten JT Laine Mika M Dirksen Maurits M Siviglia Massimo M Casella Gianni G Kala Petr P Díez Gil José Luis JL Banning Adrian A Becerra Victor V De Simone Ciro C Santucci Andrea A Carrillo Xavier X Scoccia Alessandra A Amoroso Giovanni G Lux Arpad A Kovarnik Tomas T Davlouros Periklis P Mehilli Julinda J Gabrielli Gabriele G Rios Xacobe Flores XF Bakraceski Nikola N Levesque Sébastien S Cirrincione Giuseppe G Guiducci Vincenzo V Kidawa Michał M Spedicato Leonardo L Marinucci Lucia L Ludman Peter P Zilio Filippo F Galasso Gennaro G Fabris Enrico E Menichelli Maurizio M Garcia-Touchard Arturo A Manzo Stephane S Caiazzo Gianluca G Moreu Jose J Forés Juan Sanchis JS Donazzan Luca L Vignali Luigi L Teles Rui R Benit Edouard E Agostoni Pierfrancesco P Bosa Ojeda Francisco F Lehtola Heidi H Camacho-Freiere Santiago S Kraaijeveld Adriaan A Antti Ylitalo Y Boccalatte Marco M Deharo Pierre P Martínez-Luengas Iñigo Lozano IL Scheller Bruno B Alexopoulos Dimitrios D Moreno Raul R Kedhi Elvin E Uccello Giuseppe G Faurie Benjamin B Gutierrez Barrios Alejandro A Di Uccio Fortunato Scotto FS Wilbert Bor B Smits Pieter P Cortese Giuliana G Parodi Guido G Dudek Dariusz D

Journal of the American College of Cardiology 20201101 20

<h4>Background</h4>The fear of contagion during the coronavirus disease-2019 (COVID-19) pandemic may have potentially refrained patients with ST-segment elevation myocardial infarction (STEMI) from accessing the emergency system, with subsequent impact on mortality.<h4>Objectives</h4>The ISACS-STEMI COVID-19 registry aims to estimate the true impact of the COVID-19 pandemic on the treatment and outcome of patients with STEMI treated by primary percutaneous coronary intervention (PPCI), with iden ...[more]

PMID: 33183506

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Project description:BackgroundIt has been suggested the COVID pandemic may have indirectly affected the treatment and outcome of STEMI patients, by avoidance or significant delays in contacting the emergency system. No data have been reported on the impact of diabetes on treatment and outcome of STEMI patients, that was therefore the aim of the current subanalysis conducted in patients included in the International Study on Acute Coronary Syndromes-ST Elevation Myocardial Infarction (ISACS-STEMI) COVID-19.MethodsThe ISACS-STEMI COVID-19 is a retrospective registry performed in European centers with an annual volume of > 120 primary percutaneous coronary intervention (PCI) and assessed STEMI patients, treated with primary PCI during the same periods of the years 2019 versus 2020 (March and April). Main outcomes are the incidences of primary PCI, delayed treatment, and in-hospital mortality.ResultsA total of 6609 patients underwent primary PCI in 77 centers, located in 18 countries. Diabetes was observed in a total of 1356 patients (20.5%), with similar proportion between 2019 and 2020. During the pandemic, there was a significant reduction in primary PCI as compared to 2019, similar in both patients with (Incidence rate ratio (IRR) 0.79 (95% CI: 0.73-0.85, p < 0.0001) and without diabetes (IRR 0.81 (95% CI: 0.78-0.85, p < 0.0001) (p int = 0.40). We observed a significant heterogeneity among centers in the population with and without diabetes (p < 0.001, respectively). The heterogeneity among centers was not related to the incidence of death due to COVID-19 in both groups of patients. Interaction was observed for Hypertension (p = 0.024) only in absence of diabetes. Furthermore, the pandemic was independently associated with a significant increase in door-to-balloon and total ischemia times only among patients without diabetes, which may have contributed to the higher mortality, during the pandemic, observed in this group of patients.ConclusionsThe COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a similar reduction in primary PCI procedures in both patients with and without diabetes. Hypertension had a significant impact on PCI reduction only among patients without diabetes. We observed a significant increase in ischemia time and door-to-balloon time mainly in absence of diabetes, that contributed to explain the increased mortality observed in this group of patients during the pandemic.Trial registration numberNCT04412655.

Project description:BackgroundDuring the coronavirus disease 2019 (COVID-19) pandemic, concerns have been arisen on the use of renin-angiotensin system inhibitors (RASI) due to the potentially increased expression of Angiotensin-converting-enzyme (ACE)2 and patient's susceptibility to SARS-CoV2 infection. Diabetes mellitus have been recognized favoring the coronavirus infection with consequent increase mortality in COVID-19. No data have been so far reported in diabetic patients suffering from ST-elevation myocardial infarction (STEMI), a very high-risk population deserving of RASI treatment.MethodsThe ISACS-STEMI COVID-19 registry retrospectively assessed STEMI patients treated with primary percutaneous coronary intervention (PPCI) in March/June 2019 and 2020 in 109 European high-volume primary PCI centers. This subanalysis assessed the prognostic impact of chronic RASI therapy at admission on mortality and SARS-CoV2 infection among diabetic patients.ResultsOur population is represented by 3812 diabetic STEMI patients undergoing mechanical reperfusion, 2038 in 2019 and 1774 in 2020. Among 3761 patients with available data on chronic RASI therapy, between those ones with and without treatment there were several differences in baseline characteristics, (similar in both periods) but no difference in the prevalence of SARS-CoV2 infection (1.6% vs 1.3%, respectively, p = 0.786). Considering in-hospital medication, RASI therapy was overall associated with a significantly lower in-hospital mortality (3.3% vs 15.8%, p < 0.0001), consistently both in 2019 and in 2010.ConclusionsThis is first study to investigate the impact of RASI therapy on prognosis and SARS-CoV2 infection of diabetic patients experiencing STEMI and undergoing PPCI during the COVID-19 pandemic. Both pre-admission chronic RASI therapy and in-hospital RASI did not negatively affected patients' survival during the hospitalization, neither increased the risk of SARS-CoV2 infection.Trial registration numberNCT04412655.

Dataset Information

Impact of COVID-19 Pandemic on Mechanical Reperfusion for Patients With STEMI.

Background

Objectives

Methods

Results

Conclusions

Publications

Impact of COVID-19 Pandemic on Mechanical Reperfusion for Patients With STEMI.

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