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Impact of renin-angiotensin system inhibitors on mortality during the COVID Pandemic among STEMI patients undergoing mechanical reperfusion: Insight from an international STEMI registry
G. De Luca, M. Cercek, L. Okkels Jensen, O. Bushljetikj, L. Calmac, T. Johnson, M. Gracida Blancas, V. Ganyukov, W. Wojakowski, C. von Birgelen, A. IJsselmuiden, B. Tuccillo, F. Versaci, J. Ten Berg, M. Laine, T. Berkout, G. Casella, P. Kala, B....
Language English Country France
Document type Journal Article, Multicenter Study
- MeSH
- Antihypertensive Agents therapeutic use MeSH
- COVID-19 mortality therapy MeSH
- COVID-19 Drug Treatment MeSH
- Hospitalization MeSH
- ST Elevation Myocardial Infarction mortality therapy MeSH
- Percutaneous Coronary Intervention MeSH
- Middle Aged MeSH
- Humans MeSH
- Pandemics MeSH
- Prognosis MeSH
- Registries MeSH
- Renin-Angiotensin System MeSH
- Myocardial Reperfusion * MeSH
- SARS-CoV-2 * MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
BACKGROUND: Concerns have been raised on a potential interaction between renin-angiotensin system inhibitors (RASI) and the susceptibility to coronavirus disease 2019 (COVID-19). No data have been so far reported on the prognostic impact of RASI in patients suffering from ST-elevation myocardial infarction (STEMI) during COVID-19 pandemic, which was the aim of the present study. METHODS: STEMI patients treated with primary percutaneous coronary intervention (PPCI) and enrolled in the ISACS-STEMI COVID-19 registry were included in the present sub-analysis and divided according to RASI therapy at admission. RESULTS: Our population is represented by 6095 patients, of whom 3654 admitted in 2019 and 2441 in 2020. No difference in the prevalence of SARSCoV2 infection was observed according to RASI therapy at admission (2.5% vs 2.1%, p = 0.5), which was associated with a significantly lower mortality (adjusted OR [95% CI]=0.68 [0.51-0.90], P = 0.006), confirmed in the analysis restricted to 2020 (adjusted OR [95% CI]=0.5[0.33-0.74], P = 0.001). Among the 5388 patients in whom data on in-hospital medication were available, in-hospital RASI therapy was associated with a significantly lower mortality (2.1% vs 16.7%, OR [95% CI]=0.11 [0.084-0.14], p < 0.0001), confirmed after adjustment in both periods. Among the 62 SARSCoV-2 positive patients, RASI therapy, both at admission or in-hospital, showed no prognostic effect. CONCLUSIONS: This is the first study to investigate the impact of RASI therapy on the prognosis and SARSCoV2 infection of STEMI patients undergoing PPCI during the COVID-19 pandemic. Both pre-admission and in-hospital RASI were associated with lower mortality. Among SARSCoV2-positive patients, both chronic and in-hospital RASI therapy showed no impact on survival.
AUSL IRCCS Reggio Emilia Italy
Azienda Ospedaliero Universitaria Ospedali Riuniti Trieste Italy
Azienda Ospedaliero Universitaria Sassari Italy
Center for Cardiovascular Diseases Ohrid North Macedonia
Center Hospitalier Universitaire de Poitiers Poitiers University Hospital Poitiers France
Central Hospital of Medical University of Lodz Poland
Centre for Intensive Internal Medicine University Medical Centre Ljubljana Slovenia
Clinic Emergency Hospital of Bucharest Romania
Complexo Hospetaliero Universitario La Coruna La Coruna Spain
Department of Cardiology Medisch Spectrum Twente Thoraxcentrum Twente Enschede The Netherlands
Department of Statistical Sciences University of Padova Italy
Division of Cardiology Amphia Hospital Breda The Netherlands
Division of Cardiology Attikon University Hospital Athens Greece
Division of Cardiology Azienda Ospedaliera Ospedali Riuniti Marche Nord Pesaro Italy
Division of Cardiology CHU Lariboisière AP HP Paris 7 University INSERM UMRS 942 France
Division of Cardiology Clinica Villa dei Fiori Acerra Italy
Division of Cardiology Complejo Hospitalario de Toledo Toledo Spain
Division of Cardiology Groupe Hospitalier Mutualiste de Grenoble France
Division of Cardiology Heart Centre Turku Finland
Division of Cardiology Helsinki University Central Hospital Finland
Division of Cardiology Hospital Cabueñes Gijon Spain
Division of Cardiology Hospital Clinico Universitario de Valencia Spain
Division of Cardiology Hospital de Santa Cruz CHLO Carnaxide Portugal
Division of Cardiology Hospital la Paz Madrid Spain
Division of Cardiology Hospital Puerta del Mar Cadiz Spain
Division of Cardiology Hospital Universitario de Canarias Santa Cruz de Tenerife Spain
Division of Cardiology Juan Ramon Jimenez Hospital Huelva Spain
Division of Cardiology Medical University of Silezia Katowice Poland
Division of Cardiology Northwest Clinics Alkmaar The Netherlands
Division of Cardiology Odense Universitets Hospital Odense Denmark
Division of Cardiology Ospedale A Manzoni Lecco Italy
Division of Cardiology Ospedale degli Infermi ASL Biella Italy
Division of Cardiology Ospedale del Mare Napoli Italy
Division of Cardiology Ospedale F Spaziani Frosinone Italy
Division of Cardiology Ospedale G Moscati Aversa Italy
Division of Cardiology Ospedale Maggiore Bologna Italy
Division of Cardiology Ospedale S Maurizio Bolzano Ospedale S Maurizio Bolzano Italy
Division of Cardiology Ospedale San Giovanni di Dio e Ruggi d'Aragona Salerno Italy
Division of Cardiology Ospedale Sant'Anna Ferrara Italy
Division of Cardiology Ospedale Santa Maria delle Grazie Pozzuoli Italy
Division of Cardiology Ospedale Santa Maria Goretti Latina Italy
Division of Cardiology Oulu University Hospital Finland
Division of Cardiology St Antonius Hospital Nieuwegein The Netherlands
Division of Cardiology St Jan Hospital Brugge Belgium
Division of Cardiology UMC Utrecht The Netherlands
Division of Cardiology Ziekenhuis Netwerk Antwerpen Middelheim Antwerp Belgium
H Universitario y Politécnico La Fe Valencia Spain
Hospital Clínico Universitario Virgen de la Victoria Málaga Spain
Hospital Germans Triasi Pujol Badalona Spain
Interventional Cardiology Unit Azienda Ospedaliera Sanitaria Parma Italy
Interventional Cardiology Unit Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona Italy
Interventional Cardiology Unit Heart Disease Institute Hospital Universitari de Bellvitge Spain
Invasive Cardiology and Congenital Heart Disease Patras University Hospital Patras Greece
Maastricht University Medical Center The Netherlands
Ospedale Santa Chiara di Trento Italy
Ospedale Santa Maria della Misericordia Perugia Italy
University Hospital Brno Medical Faculty of Masaryk University Brno Czech Republic
References provided by Crossref.org
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- $a De Luca, Giuseppe $u Division of Cardiology, Azienda Ospedaliero-Universitaria Maggiore della Carità, Università del Piemonte Orientale, Italy. Electronic address: giuseppe.deluca@med.uniupo.it
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- $a Impact of renin-angiotensin system inhibitors on mortality during the COVID Pandemic among STEMI patients undergoing mechanical reperfusion: Insight from an international STEMI registry / $c G. De Luca, M. Cercek, L. Okkels Jensen, O. Bushljetikj, L. Calmac, T. Johnson, M. Gracida Blancas, V. Ganyukov, W. Wojakowski, C. von Birgelen, A. IJsselmuiden, B. Tuccillo, F. Versaci, J. Ten Berg, M. Laine, T. Berkout, G. Casella, P. Kala, B. López Ledesma, V. Becerra, R. Padalino, A. Santucci, X. Carrillo, A. Scoccia, G. Amoroso, A. Lux, T. Kovarnik, P. Davlouros, G. Gabrielli, X. Flores Rios, N. Bakraceski, S. Levesque, V. Guiducci, M. Kidawa, L. Marinucci, F. Zilio, G. Galasso, E. Fabris, M. Menichelli, S. Manzo, G. Caiazzo, J. Moreu, J. Sanchis Forés, L. Donazzan, L. Vignali, R. Teles, P. Agostoni, F. Bosa Ojeda, H. Lehtola, S. Camacho-Freiere, A. Kraaijeveld, Y. Antti, G. Visconti, I. Lozano Martínez-Luengas, B. Scheller, D. Alexopulos, R. Moreno, E. Kedhi, G. Uccello, B. Faurie, A. Gutierrez Barrios, F. Scotto Di Uccio, B. Wilbert, G. Cortese, MT. Dirksen, G. Parodi, M. Verdoia
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- $a BACKGROUND: Concerns have been raised on a potential interaction between renin-angiotensin system inhibitors (RASI) and the susceptibility to coronavirus disease 2019 (COVID-19). No data have been so far reported on the prognostic impact of RASI in patients suffering from ST-elevation myocardial infarction (STEMI) during COVID-19 pandemic, which was the aim of the present study. METHODS: STEMI patients treated with primary percutaneous coronary intervention (PPCI) and enrolled in the ISACS-STEMI COVID-19 registry were included in the present sub-analysis and divided according to RASI therapy at admission. RESULTS: Our population is represented by 6095 patients, of whom 3654 admitted in 2019 and 2441 in 2020. No difference in the prevalence of SARSCoV2 infection was observed according to RASI therapy at admission (2.5% vs 2.1%, p = 0.5), which was associated with a significantly lower mortality (adjusted OR [95% CI]=0.68 [0.51-0.90], P = 0.006), confirmed in the analysis restricted to 2020 (adjusted OR [95% CI]=0.5[0.33-0.74], P = 0.001). Among the 5388 patients in whom data on in-hospital medication were available, in-hospital RASI therapy was associated with a significantly lower mortality (2.1% vs 16.7%, OR [95% CI]=0.11 [0.084-0.14], p < 0.0001), confirmed after adjustment in both periods. Among the 62 SARSCoV-2 positive patients, RASI therapy, both at admission or in-hospital, showed no prognostic effect. CONCLUSIONS: This is the first study to investigate the impact of RASI therapy on the prognosis and SARSCoV2 infection of STEMI patients undergoing PPCI during the COVID-19 pandemic. Both pre-admission and in-hospital RASI were associated with lower mortality. Among SARSCoV2-positive patients, both chronic and in-hospital RASI therapy showed no impact on survival.
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