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Impact of Smoking Status on Mortality in STEMI Patients Undergoing Mechanical Reperfusion for STEMI: Insights from the ISACS-STEMI COVID-19 Registry.

ABSTRACT: The so-called “smoking paradox”, conditioning lower mortality in smokers among STEMI patients, has seldom been addressed in the settings of modern primary PCI protocols. The ISACS−STEMI COVID-19 is a large-scale retrospective multicenter registry addressing in-hospital mortality, reperfusion, and 30-day mortality among primary PCI patients in the era of the COVID-19 pandemic. Among the 16,083 STEMI patients, 6819 (42.3%) patients were active smokers, 2099 (13.1%) previous smokers, and 7165 (44.6%) non-smokers. Despite the impaired preprocedural recanalization (p < 0.001), active smokers had a significantly better postprocedural TIMI flow compared with non-smokers (p < 0.001); this was confirmed after adjustment for all baseline and procedural confounders, and the propensity score. Active smokers had a significantly lower in-hospital (p < 0.001) and 30-day (p < 0.001) mortality compared with non-smokers and previous smokers; this was confirmed after adjustment for all baseline and procedural confounders, and the propensity score. In conclusion, in our population, active smoking was significantly associated with improved epicardial recanalization and lower in-hospital and 30-day mortality compared with previous and non-smoking history.

SUBMITTER: De Luca G

PROVIDER: S-EPMC9698021 | biostudies-literature | 2022 Nov

REPOSITORIES: biostudies-literature

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Impact of Smoking Status on Mortality in STEMI Patients Undergoing Mechanical Reperfusion for STEMI: Insights from the ISACS-STEMI COVID-19 Registry.

De Luca Giuseppe G Algowhary Magdy M Uguz Berat B Oliveira Dinaldo C DC Ganyukov Vladimir V Zimbakov Zan Z Cercek Miha M Jensen Lisette Okkels LO Loh Poay Huan PH Calmac Lucian L Ferrer Gerard Roura I GRI Quadros Alexandre A Milewski Marek M Scotto D'Uccio Fortunato F von Birgelen Clemens C Versaci Francesco F Ten Berg Jurrien J Casella Gianni G Wong Sung Lung Aaron A Kala Petr P Díez Gil José Luis JL Carrillo Xavier X Dirksen Maurits M Becerra-Munoz Victor M VM Lee Michael Kang-Yin MK Juzar Dafsah Arifa DA Joaquim Rodrigo de Moura RM Paladino Roberto R Milicic Davor D Davlouros Periklis P Bakraceski Nikola N Zilio Filippo F Donazzan Luca L Kraaijeveld Adriaan A Galasso Gennaro G Arpad Lux L Lucia Marinucci M Vincenzo Guiducci G Menichelli Maurizio M Scoccia Alessandra A Yamac Aylin Hatice AH Ugur Mert Kadir K Flores Rios Xacobe X Kovarnik Tomas T Kidawa Michal M Moreu Josè J Vincent Flavien F Fabris Enrico E Martínez-Luengas Iñigo Lozano IL Boccalatte Marco M Bosa Ojeda Francisco F Arellano-Serrano Carlos C Caiazzo Gianluca G Cirrincione Giuseppe G Kao Hsien-Li HL Sanchis Forés Juan J Vignali Luigi L Pereira Helder H Manzo Stephane S Ordoñez Santiago S Özkan Alev Arat AA Scheller Bruno B Lehtola Heidi H Teles Rui R Mantis Christos C Antti Ylitalo Y Silveira João António Brum JAB Zoni Rodrigo R Bessonov Ivan I Savonitto Stefano S Kochiadakis George G Alexopulos Dimitrios D Uribe Carlos E CE Kanakakis John J Faurie Benjamin B Gabrielli Gabriele G Barrios Alejandro Gutierrez AG Bachini Juan Pablo JP Rocha Alex A Tam Frankie Chor-Cheung FC Rodriguez Alfredo A Lukito Antonia Anna AA Saint-Joy Veauthyelau V Pessah Gustavo G Tuccillo Andrea A Cortese Giuliana G Parodi Guido G Bouraghda Mohamed Abed MA Kedhi Elvin E Lamelas Pablo P Suryapranata Harry H Nardin Matteo M Verdoia Monica M

Journal of clinical medicine 20221113 22

The so-called “smoking paradox”, conditioning lower mortality in smokers among STEMI patients, has seldom been addressed in the settings of modern primary PCI protocols. The ISACS−STEMI COVID-19 is a large-scale retrospective multicenter registry addressing in-hospital mortality, reperfusion, and 30-day mortality among primary PCI patients in the era of the COVID-19 pandemic. Among the 16,083 STEMI patients, 6819 (42.3%) patients were active smokers, 2099 (13.1%) previous smokers, and 7165 (44.6 ...[more]

PMID: 36431198

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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 Smoking Status on Mortality in STEMI Patients Undergoing Mechanical Reperfusion for STEMI: Insights from the ISACS-STEMI COVID-19 Registry.

Publications

Impact of Smoking Status on Mortality in STEMI Patients Undergoing Mechanical Reperfusion for STEMI: Insights from the ISACS-STEMI COVID-19 Registry.

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