BACKGROUND: It has been suggested the COVID pandemic may have indirectly affected the treatment and outcome of STEMI patients, by avoidance or significant delays in contacting the emergency system. No data have been reported on the impact of diabetes on treatment and outcome of STEMI patients, that was therefore the aim of the current subanalysis conducted in patients included in the International Study on Acute Coronary Syndromes-ST Elevation Myocardial Infarction (ISACS-STEMI) COVID-19. METHODS: The ISACS-STEMI COVID-19 is a retrospective registry performed in European centers with an annual volume of > 120 primary percutaneous coronary intervention (PCI) and assessed STEMI patients, treated with primary PCI during the same periods of the years 2019 versus 2020 (March and April). Main outcomes are the incidences of primary PCI, delayed treatment, and in-hospital mortality. RESULTS: A total of 6609 patients underwent primary PCI in 77 centers, located in 18 countries. Diabetes was observed in a total of 1356 patients (20.5%), with similar proportion between 2019 and 2020. During the pandemic, there was a significant reduction in primary PCI as compared to 2019, similar in both patients with (Incidence rate ratio (IRR) 0.79 (95% CI: 0.73-0.85, p < 0.0001) and without diabetes (IRR 0.81 (95% CI: 0.78-0.85, p < 0.0001) (p int = 0.40). We observed a significant heterogeneity among centers in the population with and without diabetes (p < 0.001, respectively). The heterogeneity among centers was not related to the incidence of death due to COVID-19 in both groups of patients. Interaction was observed for Hypertension (p = 0.024) only in absence of diabetes. Furthermore, the pandemic was independently associated with a significant increase in door-to-balloon and total ischemia times only among patients without diabetes, which may have contributed to the higher mortality, during the pandemic, observed in this group of patients. CONCLUSIONS: The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a similar reduction in primary PCI procedures in both patients with and without diabetes. Hypertension had a significant impact on PCI reduction only among patients without diabetes. We observed a significant increase in ischemia time and door-to-balloon time mainly in absence of diabetes, that contributed to explain the increased mortality observed in this group of patients during the pandemic. TRIAL REGISTRATION NUMBER: NCT04412655.

AUSL IRCCS Reggio Emilia Reggio Emilia Italy

Azienda Ospedaliero Universitaria Ospedali Riuniti Trieste Trieste Italy

Azienda Ospedaliero Universitaria Sassari Sassari Italy

Center for Cardiovascular Diseases Ohrid North Macedonia

Center Hospitalier Universitaire de Poitiers University Hospital Poitiers France

Central Hospital of Medical University of Lodz Łódź Poland

Centre for Intensive Internal Medicine University Medical Centre Ljubljana Slovenia

Clinic Emergency Hospital of Bucharest Bucharest Romania

Complexo Hospitaliero 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 Attikon University Hospital Athens Greece

Division of Cardiology Azienda Ospedaliero Universitaria Maggiore della Carità Università del Piemonte Orientale Novara Italy

Division of Cardiology AziendaOspedaliera Ospedali Riuniti Marche Nord Pesaro Italy

Division of Cardiology Bristol Heart Institute University Hospitals Bristol NHSFT and University of Bristol Bristol UK

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

Division of Cardiology Clinica Villa dei Fiori Acerra Italy

Division of Cardiology Clinical and Experimental Interventional Cardiology University of Saarland Saarbrücken 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 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 Valencia Spain

Division of Cardiology Hospital de Santa Cruz CHLO Carnaxide 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 Clinic Alkmaar The Netherlands

Division of Cardiology Odense Universitets Hospital Odense Danemark

Division of Cardiology Ospedale A Manzoni Lecco Lecco Italy

Division of Cardiology Ospedale degli Infermi ASL Biella Ponderano 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 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 Russia

Division of Cardiology UMC Utrecht Utrecht The Netherlands

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 L'Hospitalet de Llobregat Spain

Invasive Cardiology and Congenital Heart Disease Patras University Hospital Patras Greece

Maastricht University Medical Center Maastricht The Netherlands

Ospedale Santa Chiara di Trento Trento Italy

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

University Hospital Brno Medical Faculty of Masaryk University Brno Brno Czech Republic

University Hospital Prague Prague Czech Republic

Zobrazit více v PubMed

Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, Ren R, Leung KSM, Lau EHY, Wong JY, Xing X, Xiang N, Wu Y, Li C, Chen Q, Li D, Liu T, Zhao J, Liu M, Tu W, Chen C, Jin L, Yang R, Wang Q, Zhou S, Wang R, Liu H, Luo Y, Liu Y, Shao G, Li H, Tao Z, Yang Y, Deng Z, Liu B, Ma Z, Zhang Y, Shi G, Lam TTY, Wu JT, Gao GF, Cowling BJ, Yang B, Leung GM, Feng Z. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020;382(13):1199–1207. doi: 10.1056/NEJMoa2001316. PubMed DOI PMC

Wood S. The Mystery of the Missing STEMIs During the COVID-19 Pandemic. tctMD. 2020. https://www.tctmd.com/news/mystery-missing-stemis-during-covid-19-pandemic. Accessed 2 Apr 2020.

Garcia S, Albaghdadi MS, Meraj PM, Schmidt C, Garberich R, Jaffer FA, Dixon S, Rade JJ, Tannenbaum M, Chambers J, Huang PP, Henry TD. Reduction in ST-segment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic. J Am Coll Cardiol. 2020 doi: 10.1016/j.jacc.2020.04.011. PubMed DOI PMC

Tam CF, Cheung KS, Lam S, Wong A, Yung A, Sze M, Lam YM, Chan C, Tsang TC, Tsui M, Tse HF, Siu CW. 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(4):e006631. doi: 10.1161/CIRCOUTCOMES.120.006631. PubMed DOI PMC

Piccolo R, Bruzzese D, Mauro C, Aloia A, Baldi C, Boccalatte M, Bottiglieri G, Briguori C, Caiazzo G, Calabrò P, Cappelli-Bigazzi M, De Simone C, Di Lorenzo E, Golino P, Monda V, Perrotta R, Quaranta G, Russolillo E, Scherillo M, Tesorio T, Tuccillo B, Valva G, Villari B, Tarantini G, Varricchio A, Esposito G. Population trends in rates of percutaneous coronary revascularization for acute coronary syndromes associated with the COVID-19 outbreak. Circulation. 2020 doi: 10.1161/CIRCULATIONAHA.120.047457. PubMed DOI PMC

Roffi M, Guagliumi G, Ibanez B. The obstacle course of reperfusion for STEMI in the COVID-19 pandemics. Circulation. 2020 doi: 10.1161/CIRCULATIONAHA.120.047523. PubMed DOI PMC

De Rosa S, Spaccarotella C, Basso C, Calabrò MP, Curcio A, Filardi PP, Mancone M, Mercuro G, Muscoli S, Nodari S, Pedrinelli R, Sinagra G, Indolfi C. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era. Società Italiana di Cardiologia and the CCU Academy investigators group. Eur Heart J. 2020 doi: 10.1093/eurheartj/ehaa409. PubMed DOI PMC

De Luca G, Dirksen MT, Spaulding C, Kelbæk H, Schalij M, Thuesen L, van der Hoeven B, Vink MA, Kaiser C, Musto C, Chechi T, Spaziani G, de la Diaz Llera LS, Pasceri V, Di Lorenzo E, Violini R, Suryapranata H, Stone GW, DESERT cooperation Impact of diabetes on long-term outcome after primary angioplasty: insights from the DESERT cooperation. Diabetes Care. 2013;36(4):1020–1025. doi: 10.2337/dc12-1507. PubMed DOI PMC

De Luca G, Suryapranata H, Timmer J, Ottervanger JP, Van’t Hof AW, Hoorntje JC, Dambrink JH, Gosselink AT, de Boer MJ. Impact of routine stenting on clinical outcome in diabetic patients undergoing primary angioplasty for ST-segment elevation myocardial infarction. Diabetes Care. 2006;29(4):920–923. doi: 10.2337/diacare.29.04.06.dc05-1891. PubMed DOI

De Luca G, Małek LA, Maciejewski P, Wasek W, Niewada M, Kamiński B, Drzewiecki J, Kośmider M, Kubica J, Ruzyłło W, Peruga JZ, Dudek D, Opolski G, Dobrzycki S, Gil RJ, Witkowski A, STEMI 2003 Registry Collaborators Impact of diabetes on survival in patients with ST-segment elevation myocardial infarction treated by primary angioplasty: insights from the POLISH STEMI registry. Atherosclerosis. 2010;210(2):516–520. doi: 10.1016/j.atherosclerosis.2009.12.012. PubMed DOI

De Luca G, Gibson CM, Bellandi F, Noc M, Dudek D, Zeymer U, Arntz HR, Cutlip D, Maioli M, Zorman S, Mesquita Gabriel H, Emre A, Rakowski T, Gyongyosi M, Huber K, Van't Hof AW. Diabetes mellitus is associated with distal embolization, impaired myocardial perfusion, and higher mortality in patients with ST-segment elevation myocardial infarction treated with primary angioplasty and glycoprotein IIb-IIIa inhibitors. Atherosclerosis. 2009;207(1):181–185. doi: 10.1016/j.atherosclerosis.2009.03.042. PubMed DOI

De Luca G, Verdoia M, Cercek M, et al. Impact of COVID-19 pandemic on mechanical reperfusion for STEMI: the ISACS STEMI COVID 19 Registry. J Am Coll Cardiol. 2020;76:2321–2330. doi: 10.1016/j.jacc.2020.09.546. PubMed DOI PMC

https://ec.europa.eu/eurostat/en/web/products-eurostat-news/-/EDN-20171113-1.

Gelman A, Hill J. Data analysis using regression and multilevel/hierarchical models (Chap. 6) New York: Cambridge University Press; 2007.

Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential effects of coronaviruses on the cardiovascular system: a review. JAMA Cardiol. 2020 doi: 10.1001/jamacardio.2020.1286. PubMed DOI

Madjid M, Vela D, Khalili-Tabrizi H, Casscells SW, 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(1):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(5):1094–1099. doi: 10.1111/jth.14817. PubMed DOI PMC

Choudry FA, Hamshere SM, Rathod KS, Akhtar MM, Archbold RA, Guttmann OP, Woldman S, Jain AK, Knight CJ, Baumbach A, Mathur A, Jones DA. High thrombus burden in patients with COVID-19 presenting with ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2020;76:1168–1176. doi: 10.1016/j.jacc.2020.07.022. PubMed DOI PMC

De Luca G, Suryapranata H, Ottervanger JP, Antman EM. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation. 2004;109(10):1223–1225. doi: 10.1161/01.CIR.0000121424.76486.20. PubMed DOI

De Luca G, van’t Hof AW, de Boer MJ, Ottervanger JP, Hoorntje JC, Gosselink AT, Dambrink JH, Zijlstra F, Suryapranata H. 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. doi: 10.1016/j.ehj.2004.03.021. PubMed DOI

Sardu C, Gargiulo G, Esposito G, Paolisso G, Marfella R. Impact of diabetes mellitus on clinical outcomes in patients affected by Covid-19. Cardiovasc Diabetol. 2020;19(1):76. doi: 10.1186/s12933-020-01047-y. PubMed DOI PMC

Wu J, Mamas M, Rashid M, Weston C, Hains J, Luescher T, de Belder MA, Deanfield JE, Gale CP. Patient response, treatments and mortality for acute myocardial infarction during the COVID-19 pandemic. Eur Heart J Qual Care Clin Outcomes. 2020 doi: 10.1093/ehjqcco/qcaa062. PubMed DOI PMC

https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang.

Maddaloni E, D'Onofrio L, Alessandri F, Mignogna C, Leto G, Pascarella G, Mezzaroma I, Lichtner M, Pozzilli P, Agrò FE, Rocco M, Pugliese F, Lenzi A, Holman RR, Mastroianni CM, Buzzetti R, CoViDiab Study Group Cardiometabolic multimorbidity is associated with a worse Covid-19 prognosis than individual cardiometabolic risk factors: a multicentre retrospective study (CoViDiab II) Cardiovasc Diabetol. 2020;19(1):164. doi: 10.1186/s12933-020-01140-2. PubMed DOI PMC

Verdoia M, De Luca G. Potential role of hypovitaminosis D and Vitamin D supplementation during COVID-19 pandemic. QJM. 2020 doi: 10.1093/qjmed/hcaa234. PubMed DOI PMC

Kwok CS, Gale CP, Curzen N, de Belder MA, Ludman P, Lüscher TF, Kontopantelis E, Roebuck C, Denwood T, Burton T, Hains J, Deanfield JE, Mamas MA. Impact of the COVID-19 pandemic on percutaneous coronary intervention in england: insights from the british cardiovascular intervention society PCI database cohort. Circ Cardiovasc Interv. 2020;13(11):e009654. doi: 10.1161/CIRCINTERVENTIONS.120.009654. PubMed DOI

Baldi E, Sechi GM, Mare C, Canevari F, Brancaglione A, Primi R, Klersy C, Palo A, Contri E, Ronchi V, Beretta G, Reali F, Parogni P, Facchin F, Bua D, Rizzi U, Bussi D, Ruggeri S, Oltrona Visconti L, Savastano S, Lombardia CARe Researchers Out-of-hospital cardiac arrest during the Covid-19 outbreak in Italy. N Engl J Med. 2020 doi: 10.1056/NEJMc2010418. PubMed DOI PMC

Marijon E, Karam N, Jost D, Perrot D, Frattini B, Derkenne C, Sharifzadehgan A, Waldmann V, Beganton F, Narayanan K, Lafont A, Bougouin W, Jouven X. Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study. Lancet Public Health. 2020;S2468–2667(20):30117–30121. PubMed PMC

Mitra B, Mitchell RD, Cloud GC, Stub D, Nguyen M, Nanayakkara S, Miller JP, O’Reilly MG, Smit V, Cameron PA. Presentations of stroke and acute myocardial infarction in the first 28 days following the introduction of State of Emergency restrictions for COVID-19. Emerg Med Australas. 2020;32(6):1040–1045. doi: 10.1111/1742-6723.13621. PubMed DOI PMC

De Filippo O, D'Ascenzo F, Angelini F, Bocchino PP, Conrotto F, Saglietto A, Secco GG, Campo G, Gallone G, Verardi R, Gaido L, Iannaccone M, Galvani M, Ugo F, Barbero U, Infantino V, Olivotti L, Mennuni M, Gili S, Infusino F, Vercellino M, Zucchetti O, Casella G, Giammaria M, Boccuzzi G, Tolomeo P, Doronzo B, Senatore G, Grosso Marra W, Rognoni A, Trabattoni D, Franchin L, Borin A, Bruno F, Galluzzo A, Gambino A, Nicolino A, Truffa Giachet A, Sardella G, Fedele F, Monticone S, Montefusco A, Omedè P, Pennone M, Patti G, Mancone M, De Ferrari GM. reduced rate of hospital admissions for ACS during Covid-19 outbreak in Northern Italy. N Engl J Med. 2020;383(1):88–89. doi: 10.1056/NEJMc2009166. PubMed DOI PMC

Stefanini GG, Montorfano M, Trabattoni D, Andreini D, Ferrante G, Ancona M, Metra M, Curello S, Maffeo D, Pero G, Cacucci M, Assanelli E, Bellini B, Russo F, Ielasi A, Tespili M, Danzi GB, Vandoni P, Bollati M, Barbieri L, Oreglia J, Lettieri C, Cremonesi A, Carugo S, Reimers B, Condorelli G, Chieffo A. ST-elevation myocardial infarction in patients with COVID-19: clinical and angiographic outcomes. Circulation. 2020 doi: 10.1161/CIRCULATIONAHA.120.047525. PubMed DOI PMC

de Abajo FJ, Rodríguez-Martín S, Lerma V, Mejía-Abril G, Aguilar M, García-Luque A, Laredo L, Laosa O, Centeno-Soto GA, Ángeles Gálvez M, Puerro M, González-Rojano E, Pedraza L, de Pablo I, Abad-Santos F, Rodríguez-Mañas L, Gil M, Tobías A, Rodríguez-Miguel A, Rodríguez-Puyol D. Use of renin-angiotensin-aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: a case-population study. Lancet. 2020 doi: 10.1016/S0140-6736(20)31030-8. PubMed DOI PMC

Sama IE, Ravera A, Santema BT, van Goor H, Ter Maaten JM, Cleland JGF, Rienstra M, Friedrich AW, Samani NJ, Ng LL, Dickstein K, Lang CC, Filippatos G, Anker SD, Ponikowski P, Metra M, van Veldhuisen DJ, Voors AA. 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(19):1810–1817. doi: 10.1093/eurheartj/ehaa373. PubMed DOI 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 doi: 10.1161/HYPERTENSIONAHA.120.15572. PubMed DOI

Brace Corona Trial. https://www.escardio.org/The-ESC/Press-Office/Press-releases/LOPES.

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

The management of type 2 diabetes before, during and after Covid-19 infection: what is the evidence?

Zobrazit více v PubMed

ClinicalTrials.gov
NCT04412655