TY - JOUR
T1 - Impact of COVID-19 pandemic and diabetes on mechanical reperfusion in patients with STEMI
T2 - insights from the ISACS STEMI COVID 19 Registry
AU - De Luca, Giuseppe
AU - Cercek, Miha
AU - Jensen, Lisette Okkels
AU - Vavlukis, Marija
AU - Calmac, Lucian
AU - Johnson, Tom
AU - Roura i Ferrer, Gerard
AU - Ganyukov, Vladimir
AU - Wojakowski, Wojtek
AU - von Birgelen, Clemens
AU - Versaci, Francesco
AU - Ten Berg, Jurrien
AU - Laine, Mika
AU - Dirksen, Maurits
AU - Casella, Gianni
AU - Kala, Petr
AU - Díez Gil, José Luis
AU - Becerra, Victor
AU - De Simone, Ciro
AU - Carrill, Xavier
AU - Scoccia, Alessandra
AU - Lux, Arpad
AU - Kovarnik, Tomas
AU - Davlouros, Periklis
AU - Gabrielli, Gabriele
AU - Flores Rios, Xacobe
AU - Bakraceski, Nikola
AU - Levesque, Sébastien
AU - Guiducci, Vincenzo
AU - Kidawa, Michał
AU - Marinucci, Lucia
AU - Zilio, Filippo
AU - Galasso, Gennaro
AU - Fabris, Enrico
AU - Menichelli, Maurizio
AU - Manzo, Stephane
AU - Caiazzo, Gianluca
AU - Moreu, Jose
AU - Sanchis Forés, Juan
AU - Donazzan, Luca
AU - Vignali, Luigi
AU - Teles, Rui
AU - Bosa Ojeda, Francisco
AU - Lehtola, Heidi
AU - Camacho-Freiere, Santiago
AU - Kraaijeveld, Adriaan
AU - Antti, Ylitalo
AU - Boccalatte, Marco
AU - Martínez-Luengas, Iñigo Lozano
AU - Scheller, Bruno
AU - Alexopoulos, Dimitrios
AU - Uccello, Giuseppe
AU - Faurie, Benjamin
AU - Gutierrez Barrios, Alejandro
AU - Wilbert, Bor
AU - Cortese, Giuliana
AU - Moreno, Raul
AU - Parodi, Guido
AU - Kedhi, Elvin
AU - Verdoia, Monica
N1 - Funding Information:
The study was promoted and partially funded by the Aging Project-Department of Excellence, Department of Translational Medicine, Eastern Piedmont University, Novara, Italy.
Funding Information:
Giuliana Cortese was funded by PRIN2017 (20178S4EK9).
Publisher Copyright:
© 2020, The Author(s).
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/12
Y1 - 2020/12
N2 - Background: It 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. Methods: The 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. Results: A 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. Conclusions: The 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 number: NCT 04412655.
AB - Background: It 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. Methods: The 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. Results: A 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. Conclusions: The 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 number: NCT 04412655.
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U2 - 10.1186/s12933-020-01196-0
DO - 10.1186/s12933-020-01196-0
M3 - Article
C2 - 33339541
AN - SCOPUS:85097797743
VL - 19
JO - Cardiovascular Diabetology
JF - Cardiovascular Diabetology
SN - 1475-2840
IS - 1
M1 - 215
ER -