Age-Related Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI: Results of the ISACS-STEMI COVID-19 Registry
Publication date
2023-03-08
Authors
De Luca, Giuseppe
Algowhary, Magdy
Uguz, Berat
Oliveira, Dinaldo C
Ganyukov, Vladimir
Busljetik, Oliver
Cercek, Miha
Jensen, Lisette Okkels
Loh, Poay Huan
Calmac, Lucian
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Advisors
Supervisors
Document Type
Article
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Abstract
BACKGROUND: The constraints in the management of patients with ST-segment elevation myocardial infarction (STEMI) during the COVID-19 pandemic have been suggested to have severely impacted mortality levels. The aim of the current analysis is to evaluate the age-related effects of the COVID-19 pandemic on mechanical reperfusion and 30-day mortality for STEMI within the registry ISACS-STEMI COVID-19. METHODS: This retrospective multicenter registry was performed in high-volume PPCI centers on four continents and included STEMI patients undergoing PPCI in March-June 2019 and 2020. Patients were divided according to age (< or ≥75 years). The main outcomes were the incidence and timing of PPCI, (ischemia time longer than 12 h and door-to-balloon longer than 30 min), and in-hospital or 30-day mortality. RESULTS: We included 16,683 patients undergoing PPCI in 109 centers. In 2020, during the pandemic, there was a significant reduction in PPCI as compared to 2019 (IRR 0.843 (95%-CI: 0.825-0.861, p < 0.0001). We found a significant age-related reduction (7%, p = 0.015), with a larger effect on elderly than on younger patients. Furthermore, we observed significantly higher 30-day mortality during the pandemic period, especially among the elderly (13.6% vs. 17.9%, adjusted HR (95% CI) = 1.55 [1.24-1.93], p < 0.001) as compared to younger patients (4.8% vs. 5.7%; adjusted HR (95% CI) = 1.25 [1.05-1.49], p = 0.013), as a potential consequence of the significantly longer ischemia time observed during the pandemic. CONCLUSIONS: The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a 16% reduction in PPCI procedures, with a larger reduction and a longer delay to treatment among elderly patients, which may have contributed to increase in-hospital and 30-day mortality during the pandemic.
Keywords
COVID-19, ST-segment elevation myocardial infarction, ageing, General Medicine
Citation
De Luca, G, Algowhary, M, Uguz, B, Oliveira, D C, Ganyukov, V, Busljetik, O, Cercek, M, Jensen, L O, Loh, P H, Calmac, L, Ferrer, G R I, Quadros, A, Milewski, M, Scotto D'Uccio, F, von Birgelen, C, Versaci, F, Ten Berg, J, Casella, G, Wong Sung Lung, A, Kala, P, Díez Gil, J L, Carrillo, X, Dirksen, M, Becerra Munoz, V, Lee, M K-Y, Juzar, D A, de Moura Joaquim, R, Paladino, R, Milicic, D, Davlouros, P, Bakraceski, N, Zilio, F, Donazzan, L, Kraaijeveld, A, Galasso, G, Arpad, L, Marinucci, L, Guiducci, V, Menichelli, M, Scoccia, A, Yamac, A H, Ugur Mert, K, Flores Rios, X, Kovarnik, T, Kidawa, M, Moreu, J, Flavien, V, Fabris, E, Martínez-Luengas, I L, Boccalatte, M, Bosa Ojeda, F, Arellano-Serrano, C, Caiazzo, G, Cirrincione, G, Kao, H-L, Sanchis Forés, J, Vignali, L, Pereira, H, Manzo-Silberman, S, Ordoñez, S, Arat Özkan, A, Scheller, B, Lehitola, H, Teles, R, Mantis, C, Antti, Y, Brum Silveira, J A, Zoni, C R, Bessonov, I, Uccello, G, Kochiadakis, G, Alexopulos, D, Uribe, C E, Kanakakis, J, Faurie, B, Gabrielli, G, Gutierrez Barrios, A, Bachini, J P, Rocha, A, Tam, F C C, Rodriguez, A, Lukito, A A, Saint-Joy, V, Pessah, G, Tuccillo, A, Ielasi, A, Cortese, G, Parodi, G, Burgadha, M A, Kedhi, E, Lamelas, P, Suryapranata, H, Nardin, M & Verdoia, M 2023, 'Age-Related Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI : Results of the ISACS-STEMI COVID-19 Registry', Journal of Clinical medicine, vol. 12, no. 6, 2116. https://doi.org/10.3390/jcm12062116