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.
Age-Related Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI: Results of the ISACS-STEMI COVID-19 Registry / 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.; Diez 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.; Martinez-Luengas, I. L.; Boccalatte, M.; Bosa Ojeda, F.; Arellano-Serrano, C.; Caiazzo, G.; Cirrincione, G.; Kao, H. -L.; Sanchis Fores, J.; Vignali, L.; Pereira, H.; Manzo-Silberman, S.; Ordonez, S.; Arat Ozkan, 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.. - In: JOURNAL OF CLINICAL MEDICINE. - ISSN 2077-0383. - 12:6(2023). [10.3390/jcm12062116]
Age-Related Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI: Results of the ISACS-STEMI COVID-19 Registry
De Luca G.;Parodi G.;
2023-01-01
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
