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 Azienda Ospedaliero Universitaria Maggiore della Carità Università del Piemonte Orientale Italy

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

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 Clinical and Experimental Interventional Cardiology University of Saarland Germany

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

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

Onze Lieve Gasthuis; Amsterdam The Netherlands

Ospedale Santa Chiara di 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 Brno Medical Faculty of Masaryk University Brno Czech Republic

University Hospital Prague Czech Republic

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