BACKGROUND: The fear of contagion during the coronavirus disease-2019 (COVID-19) pandemic may have potentially refrained patients with ST-segment elevation myocardial infarction (STEMI) from accessing the emergency system, with subsequent impact on mortality. OBJECTIVES: The ISACS-STEMI COVID-19 registry aims to estimate the true impact of the COVID-19 pandemic on the treatment and outcome of patients with STEMI treated by primary percutaneous coronary intervention (PPCI), with identification of "at-risk" patient cohorts for failure to present or delays to treatment. METHODS: This retrospective registry was performed in European high-volume PPCI centers and assessed patients with STEMI treated with PPPCI in March/April 2019 and 2020. Main outcomes are the incidences of PPCI, delayed treatment, and in-hospital mortality. RESULTS: A total of 6,609 patients underwent PPCI in 77 centers, located in 18 countries. In 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio: 0.811; 95% confidence interval: 0.78 to 0.84; p < 0.0001). The heterogeneity among centers was not related to the incidence of death due to COVID-19. A significant interaction was observed for patients with arterial hypertension, who were less frequently admitted in 2020 than in 2019. Furthermore, the pandemic was associated with a significant increase in door-to-balloon and total ischemia times, which may have contributed to the higher mortality during the pandemic. CONCLUSIONS: The COVID-19 pandemic had significant impact on the treatment of patients with STEMI, with a 19% reduction in PPCI procedures, especially among patients suffering from hypertension, and a longer delay to treatment, which may have contributed to the increased mortality during the pandemic. (Primary Angioplasty for STEMI During COVID-19 Pandemic [ISACS-STEMI COVID-19] Registry; NCT04412655).

AUSL IRCCS Reggio Emilia Italy

Azienda Ospedaliero Universitaria Ospedali Riuniti Trieste Italy

Azienda Ospedaliero Universitaria Sassari 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 Lodz Poland

Centre for Intensive Internal Medicine University Medical Centre Ljubljana Slovenia

Charles University Hospital Prague Czech Republic

Clinic Emergency Hospital of Bucharest 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 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 Azienda Ospedaliero Universitaria Maggiore della Carità Università del Piemonte Orientale Novara Italy

Division of Cardiology Bristol Heart Institute University Hospitals Bristol NHSFT and University of Bristol Bristol United Kingdom

Division of Cardiology CHU Lariboisière AP HP Paris 7 University INSERM UMRS 942 Paris France

Division of Cardiology CHU Timone Aix Marseille Université Marseille France

Division of Cardiology Clinica Villa dei Fiori Acerra Italy

Division of Cardiology Clinical and Experimental Interventional Cardiology University of Saarland Homburg Germany

Division of Cardiology Complejo Hospitalario de Toledo Toledo Spain

Division of Cardiology Groupe Hospitalier Mutualiste de Grenoble Grenoble France

Division of Cardiology Heart Centre Turku University Hospital Turku Finland

Division of Cardiology Helsinki University Central Hospital Helsinki 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 Lisbon Portugal

Division of Cardiology Hospital la Paz Madrid Spain

Division of Cardiology Hospital Puerta de Hierro Majadahonda 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 Jessa Ziekenhuis Hasselt Belgium

Division of Cardiology Juan Ramon Jimenez Hospital Huelva Spain

Division of Cardiology Maasstad Ziekenhuis Rotterdam the Netherlands

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 Civico Arnas Palermo Italy

Division of Cardiology Ospedale degli Infermi ASL Biella 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 della Misericordia Udine Italy

Division of Cardiology Ospedale Santa Maria delle Grazie Pozzuoli Italy

Division of Cardiology Ospedale Santa Maria Goretti Latina Italy

Division of Cardiology Ospedali Riuniti Reggio Calabria Italy

Division of Cardiology Oulu University Hospital Oulu Finland

Division of Cardiology St Antonius Hospital Nieuwegein the Netherlands

Division of Cardiology St Jan Hospital Brugge Belgium

Division of Cardiology State Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Kemerovo Russia

Division of Cardiology UMC Utrecht the Netherlands

Division of Cardiology University Hospital Dijon France

Division of Cardiology University Hospital of Wales Cardiff United Kingdom

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

Institute of Cardiology Jagiellonian University Medical College Krakow Poland

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 Barcelona Spain

Invasive Cardiology and Congenital Heart Disease Patras University Hospital Patras Greece

John Radcliffe Hospital Oxford United Kingdom

Mastricht University Medical Center Maastricht the Netherlands

Onze Lieve Vrouwe Gasthuis Amsterdam the Netherlands

Ospedale Santa Chiara Trento Italy

Ospedale Santa Maria della Misericordia Perugia Italy

University Clinic for Cardiology Medical Faculty Ss' Cyril and Methodius University Skopje North Macedonia

University Hospital Birmingham Birmingham United Kingdom

University Hospital Brno Medical Faculty of Masaryk University Brno Czech Republic

University Hospital Munich Ludwig Maximilians University Munich Germany

Komentář v

J Am Coll Cardiol. 2020 Nov 17;76(20):2331-2333. doi: 10.1016/j.jacc.2020.09.596. PubMed

Zobrazit více v PubMed

Li Q., Guan X., Wu P. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382:1199–1207. PubMed PMC

Wood S. The mystery of the missing STEMIs during the COVID-19 pandemic. tctMD. https://www.tctmd.com/news/mystery-missing-stemis-during-covid-19- pandemic Available at:

Garcia S., Albaghdadi M.S., Meraj P.M. Reduction in ST-segment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic. J Am Coll Cardiol. 2020;75:2871–2872. PubMed PMC

Tam C.F., Cheung K.S., Lam S. Impact of Coronavirus Disease 2019 (COVID-19) outbreak on ST-segment-elevation myocardial infarction care in Hong Kong, China. Circ Cardiovasc Qual Outcomes. 2020;13 PubMed PMC

Piccolo R., Bruzzese D., Mauro C. Population trends in rates of percutaneous coronary revascularization for acute coronary syndromes associated with the COVID-19 outbreak. Circulation. 2020;141:2035–2037. PubMed PMC

Roffi M., Guagliumi G., Ibanez B. The obstacle course of reperfusion for STEMI in the COVID-19 pandemics. Circulation. 2020;141:1951–1953. PubMed PMC

De Rosa S., Spaccarotella C., Basso C. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era. SocietàItaliana di Cardiologia and the CCU Academy investigators group. Eur Heart J. 2020;41:2083–2088. PubMed PMC

De Luca G., Suryapranata H., Ottervanger J.P., Antman E.M. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation. 2004;109:1223–1225. PubMed

De Luca G., van 't Hof A.W., de Boer M.J. Time-to-treatment significantly affects the extent of ST-segment resolution and myocardial blush in patients with acute myocardial infarction treated by primary angioplasty. Eur Heart J. 2004;25:1009–1013. PubMed

Ibanez B., James S., Agewall S., ESC Scientific Document Group 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC) Eur Heart J. 2018;39:119–177. PubMed

Gelman A., Hill J. Cambridge University Press (Chap. 6); New York: 2007. Generalized linear models. In: Data analysis using regression and multilevel/hierarchical models. p. 109-133.

Madjid M., Safavi-Naeini P., Solomon S.D., Vardeny O. Potential effects of coronaviruses on the cardiovascular system: a review. JAMA Cardiol. 2020;5:831–840. PubMed

Madjid M., Vela D., Khalili-Tabrizi H., Casscells S.W., Litovsky S. Systemic infections cause exaggerated local inflammation in atherosclerotic coronary arteries: clues to the triggering effect of acute infections on acute coronary syndromes. Tex Heart Inst J. 2007;34:11–18. PubMed PMC

Tang N., Bai H., Chen X., Gong J., Li D., Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020;18:1094–1099. PubMed PMC

Gao C., Cai Y., Zhang K. Association of hypertension and antihypertensive treatment with COVID-19 mortality: a retrospective observational study. Eur Heart J. 2020;41:2058–2066. PubMed PMC

European Society of Cardiology Position statement of the ESC Council on Hypertension on ACE-inhibitors and angiotensin receptor blockers. https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang Available at: Accessed June 2, 2020.

Baldi E., Sechi G.M., Mare C., Lombardia CARe Researchers Out-of-hospital cardiac arrest during the Covid-19 outbreak in Italy. N Engl J Med. 2020;383:496–498. PubMed PMC

Marijon E., Karam N., Jost D. Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study. Lancet Public Health. 2020;5:e437–e443. PubMed PMC

Stefanini G.G., Montorfano M., Trabattoni D. ST-elevation myocardial infarction in patients with COVID-19: clinical and angiographic outcomes. Circulation. 2020;141:2113–2116. PubMed PMC

de Abajo F.J., Rodríguez-Martín S., Lerma V. MED-ACE2-COVID19 study group. Use of renin-angiotensin-aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: a case-population study. Lancet. 2020;395:1705–1714. PubMed PMC

Sama I.E., Ravera A., Santema B.T. Circulating plasma concentrations of angiotensin-converting enzyme 2 in men and women with heart failure and effects of renin-angiotensin-aldosterone inhibitors. Eur Heart J. 2020;41:1810–1817. PubMed PMC

Guo X., Zhu Y., Hong Y. Decreased mortality of covid-19 with renin-angiotensin-aldosterone system inhibitors therapy in patients with hypertension: a meta-analysis. Hypertension. 2020;76:e13–e14. PubMed

Impacts of COVID-19 pandemic through decomposition of life expectancy according to leading causes and place of death in Czechia

Age-Related Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI: Results of the ISACS-STEMI COVID-19 Registry

Gender Difference in the Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI: Results of the ISACS-STEMI COVID-19 Registry

Impact of Smoking Status on Mortality in STEMI Patients Undergoing Mechanical Reperfusion for STEMI: Insights from the ISACS-STEMI COVID-19 Registry

Impact of chronic obstructive pulmonary disease on short-term outcome in patients with ST-elevation myocardial infarction during COVID-19 pandemic: insights from the international multicenter ISACS-STEMI registry

Renin-angiotensin system inhibitors and mortality among diabetic patients with STEMI undergoing mechanical reperfusion during the COVID-19 pandemic

Impact of SARS-CoV-2 positivity on clinical outcome among STEMI patients undergoing mechanical reperfusion: Insights from the ISACS STEMI COVID 19 registry

Impact of COVID-19 pandemic and diabetes on mechanical reperfusion in patients with STEMI: insights from the ISACS STEMI COVID 19 Registry

Zobrazit více v PubMed

ClinicalTrials.gov
NCT04412655