TY - JOUR
T1 - COVID-19 pandemic, mechanical reperfusion and 30-day mortality in ST elevation myocardial infarction
AU - De Luca, Giuseppe
AU - Algowhary, Magdy
AU - Uguz, Berat
AU - Oliveira, Dinaldo C.
AU - Ganyukov, Vladimir
AU - Zimbakov, Zan
AU - Cercek, Miha
AU - Jensen, Lisette Okkels
AU - Loh, Poay Huan
AU - Calmac, Lucian
AU - Roura-Ferrer, Gerard
AU - Quadros, Alexandre
AU - Milewski, Marek
AU - Scotto di Uccio, Fortunato
AU - von Birgelen, Clemens
AU - Versaci, Francesco
AU - Ten Berg, Jurriën
AU - Casella, Gianni
AU - Wong, Aaron Sung Lung
AU - Kala, Petr
AU - Diez Gil, Jose Luis
AU - Carrillo, Xavier
AU - Dirksen, Maurits Theodoor
AU - Becerra-Muñoz, Víctor Manuel
AU - Kang-Yin Lee, Michael
AU - Juzar, Dafsah A.
AU - de Moura Joaquim, Rodrigo
AU - Paladino, Roberto
AU - Milicic, Davor
AU - Davlouros, Periklis
AU - Bakraceski, Nikola
AU - Zilio, Filippo
AU - Donazzan, Luca
AU - Kraaijeveld, Adriaan O.
AU - Galasso, Gennaro
AU - Lux, Arpad
AU - Marinucci, Lucia
AU - Guiducci, Vincenzo
AU - Menichelli, Maurizio
AU - Scoccia, Alessandra
AU - Yamac, Aylin
AU - Ugur Mert, Kadir
AU - Flores Rios, Xacobe
AU - Kovarnik, Tomas
AU - Kidawa, Michal
AU - Moreu, Jose
AU - Flavien, Vincent
AU - Fabris, Enrico
AU - Lozano Martìnez-Luengas, Iñigo
AU - Teles, Rui
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2022/3/1
Y1 - 2022/3/1
N2 - OBJECTIVE: The initial data of the International Study on Acute Coronary Syndromes - ST Elevation Myocardial Infarction COVID-19 showed in Europe a remarkable reduction in primary percutaneous coronary intervention procedures and higher in-hospital mortality during the initial phase of the pandemic as compared with the prepandemic period. The aim of the current study was to provide the final results of the registry, subsequently extended outside Europe with a larger inclusion period (up to June 2020) and longer follow-up (up to 30 days). METHODS: This is a retrospective multicentre registry in 109 high-volume primary percutaneous coronary intervention (PPCI) centres from Europe, Latin America, South-East Asia and North Africa, enrolling 16 674 patients with ST segment elevation myocardial infarction (STEMI) undergoing PPPCI in March/June 2019 and 2020. The main study outcomes were the incidence of PPCI, delayed treatment (ischaemia time >12 hours and door-to-balloon >30 min), in-hospital and 30-day mortality. RESULTS: In 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio 0.843, 95% CI 0.825 to 0.861, p<0.0001). This reduction was significantly associated with age, being higher in older adults (>75 years) (p=0.015), and was not related to the peak of cases or deaths due to COVID-19. The heterogeneity among centres was high (p<0.001). Furthermore, the pandemic was associated with a significant increase in door-to-balloon time (40 (25-70) min vs 40 (25-64) min, p=0.01) and total ischaemia time (225 (135-410) min vs 196 (120-355) min, p<0.001), which may have contributed to the higher in-hospital (6.5% vs 5.3%, p<0.001) and 30-day (8% vs 6.5%, p=0.001) mortality observed during the pandemic. CONCLUSION: Percutaneous revascularisation for STEMI was significantly affected by the COVID-19 pandemic, with a 16% reduction in PPCI procedures, especially among older patients (about 20%), and longer delays to treatment, which may have contributed to the increased in-hospital and 30-day mortality during the pandemic. TRIAL REGISTRATION NUMBER: NCT04412655.
AB - OBJECTIVE: The initial data of the International Study on Acute Coronary Syndromes - ST Elevation Myocardial Infarction COVID-19 showed in Europe a remarkable reduction in primary percutaneous coronary intervention procedures and higher in-hospital mortality during the initial phase of the pandemic as compared with the prepandemic period. The aim of the current study was to provide the final results of the registry, subsequently extended outside Europe with a larger inclusion period (up to June 2020) and longer follow-up (up to 30 days). METHODS: This is a retrospective multicentre registry in 109 high-volume primary percutaneous coronary intervention (PPCI) centres from Europe, Latin America, South-East Asia and North Africa, enrolling 16 674 patients with ST segment elevation myocardial infarction (STEMI) undergoing PPPCI in March/June 2019 and 2020. The main study outcomes were the incidence of PPCI, delayed treatment (ischaemia time >12 hours and door-to-balloon >30 min), in-hospital and 30-day mortality. RESULTS: In 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio 0.843, 95% CI 0.825 to 0.861, p<0.0001). This reduction was significantly associated with age, being higher in older adults (>75 years) (p=0.015), and was not related to the peak of cases or deaths due to COVID-19. The heterogeneity among centres was high (p<0.001). Furthermore, the pandemic was associated with a significant increase in door-to-balloon time (40 (25-70) min vs 40 (25-64) min, p=0.01) and total ischaemia time (225 (135-410) min vs 196 (120-355) min, p<0.001), which may have contributed to the higher in-hospital (6.5% vs 5.3%, p<0.001) and 30-day (8% vs 6.5%, p=0.001) mortality observed during the pandemic. CONCLUSION: Percutaneous revascularisation for STEMI was significantly affected by the COVID-19 pandemic, with a 16% reduction in PPCI procedures, especially among older patients (about 20%), and longer delays to treatment, which may have contributed to the increased in-hospital and 30-day mortality during the pandemic. TRIAL REGISTRATION NUMBER: NCT04412655.
KW - COVID-19
KW - myocardial infarction
KW - percutaneous coronary intervention
UR - http://www.scopus.com/inward/record.url?scp=85125289272&partnerID=8YFLogxK
U2 - 10.1136/heartjnl-2021-319750
DO - 10.1136/heartjnl-2021-319750
M3 - Article
C2 - 34711661
AN - SCOPUS:85125289272
SN - 1468-201X
VL - 108
SP - 458
EP - 466
JO - Heart (British Cardiac Society)
JF - Heart (British Cardiac Society)
IS - 6
ER -