학술논문
Age-Related Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI: Results of the ISACS-STEMI COVID-19 Registry
International Study on Acute Coronary Syndromes-ST-elevation myocardial infarction
International Study on Acute Coronary Syndromes-ST-elevation myocardial infarction
Document Type
Report
Author
De Luca, Giuseppe; Algowhary, Magdy; Uguz, Berat; Oliveira, Dinaldo C.; Ganyukov, Vladimir; Busljetik, Oliver; Cercek, Miha; Jensen, Lisette Okkels; Loh, Poay Huan; Calmac, Lucian; Ferrer, Gerard Roura i; Quadros, Alexandre; Milewski, Marek; Scotto D’Uccio, Fortunato; von Birgelen, Clemens; Versaci, Francesco; Ten Berg, Jurrien; Casella, Gianni; Wong Sung Lung, Aaron; Kala, Petr; Díez Gil, José Luis; Carrillo, Xavier; Dirksen, Maurits; Becerra Munoz, Victor; Lee, Michael Kang-yin; Juzar, Dafsah Arifa; de Moura Joaquim, Rodrigo; Paladino, Roberto; Milicic, Davor; Davlouros, Periklis; Bakraceski, Nikola; Zilio, Filippo; Donazzan, Luca; Kraaijeveld, Adriaan; Galasso, Gennaro; Arpad, Lux; Marinucci, Lucia; Guiducci, Vincenzo; Menichelli, Maurizio; Scoccia, Alessandra; Yamac, Aylin Hatice; Ugur Mert, Kadir; Flores Rios, Xacobe; Kovarnik, Tomas; Kidawa, Michal; Moreu, Josè; Flavien, Vincent; Fabris, Enrico; Martínez-Luengas, Iñigo Lozano; Boccalatte, Marco; Bosa Ojeda, Francisco; Arellano-Serrano, Carlos; Caiazzo, Gianluca; Cirrincione, Giuseppe; Kao, Hsien-Li; Sanchis Forés, Juan; Vignali, Luigi; Pereira, Helder; Manzo-Silberman, Stephane; Ordoñez, Santiago; Arat Özkan, Alev; Scheller, Bruno; Lehitola, Heidi; Teles, Rui; Mantis, Christos; Antti, Ylitalo; Brum Silveira, João António; Zoni, Cesar Rodrigo; Bessonov, Ivan; Uccello, Giuseppe; Kochiadakis, George; Alexopulos, Dimitrios; Uribe, Carlos E.; Kanakakis, John; Faurie, Benjamin; Gabrielli, Gabriele; Gutierrez Barrios, Alejandro; Bachini, Juan Pablo; Rocha, Alex; Tam, Frankie C. C.; Rodriguez, Alfredo; Lukito, Antonia Anna; Saint-Joy, Veauthyelau; Pessah, Gustavo; Tuccillo, Andrea; Ielasi, Alfonso; Cortese, Giuliana; Parodi, Guido; Burgadha, Mohammed Abed; Kedhi, Elvin; Lamelas, Pablo; Suryapranata, Harry; Nardin, Matteo; Verdoia, Monica
Source
Journal of Clinical Medicine. March 2023, Vol. 12 Issue 6
Subject
Language
English
ISSN
2077-0383
Abstract
Author(s): Giuseppe De Luca (corresponding author) [1,2,3,*]; Magdy Algowhary [4]; Berat Uguz [5]; Dinaldo C. Oliveira [6]; Vladimir Ganyukov [7]; Oliver Busljetik [8]; Miha Cercek [9]; Lisette Okkels Jensen [10]; [...]
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.
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.