BACKGROUND: The constraints in the management of patients with ST-segment elevation myocardial infarction (STEMI) during the COVID-19 pandemic have been suggested to have severely impacted mortality levels. The aim of the current analysis is to evaluate the age-related effects of the COVID-19 pandemic on mechanical reperfusion and 30-day mortality for STEMI within the registry ISACS-STEMI COVID-19. METHODS: This retrospective multicenter registry was performed in high-volume PPCI centers on four continents and included STEMI patients undergoing PPCI in March-June 2019 and 2020. Patients were divided according to age (< or ≥75 years). The main outcomes were the incidence and timing of PPCI, (ischemia time longer than 12 h and door-to-balloon longer than 30 min), and in-hospital or 30-day mortality. RESULTS: We included 16,683 patients undergoing PPCI in 109 centers. In 2020, during the pandemic, there was a significant reduction in PPCI as compared to 2019 (IRR 0.843 (95%-CI: 0.825-0.861, p < 0.0001). We found a significant age-related reduction (7%, p = 0.015), with a larger effect on elderly than on younger patients. Furthermore, we observed significantly higher 30-day mortality during the pandemic period, especially among the elderly (13.6% vs. 17.9%, adjusted HR (95% CI) = 1.55 [1.24-1.93], p < 0.001) as compared to younger patients (4.8% vs. 5.7%; adjusted HR (95% CI) = 1.25 [1.05-1.49], p = 0.013), as a potential consequence of the significantly longer ischemia time observed during the pandemic. CONCLUSIONS: The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a 16% reduction in PPCI procedures, with a larger reduction and a longer delay to treatment among elderly patients, which may have contributed to increase in-hospital and 30-day mortality during the pandemic.

Azienda Ospedaliero Universitaria Ospedali Riuniti Trieste 34142 Trieste Italy

Cardiology Azienda Ospedaliera Lavagna 16033 Lavagna Italy

Cardiology Department Hospital Garcia de Orta Pragal 2805 267 Almada Portugal

Cardiology Division Department of Internal Medicine National Taiwan University Hospital 8865 Taipei 600 Taiwan

Cardiology H Universitario y Politécnico La Fe 46001 Valencia Spain

Cardiology Institute Instanbul University 34000 Istanbul Türkiye

Center for Cardiovascular Diseases 6000 Ohrid North Macedonia

Center Hospitalierd'Antibes Juan Les Pins 06600 Antibes France

Central Hospital Medical University of Lodz 90 008 Lodz Poland

Clinic Emergency Hospital of Bucharest 010001 Bucharest Romania

Complexo Hospetaliero Universitario La Coruna 15001 La Coruna Spain

Department of Cardiology and Cardiovascular Interventions Instituto Nacional de Cirugía Cardíaca Montevideo 11700 Uruguay

Department of Cardiology and Vascular Medicine University of Indonesia National Cardiovascular Center Harapan Kita Jakarta 11402 Indonesia

Department of Cardiology Hospital Bezmialem Vakıf University 34093 Istanbul Türkiye

Department of Cardiology Medical Center Ljubljana 1000 Ljubljana Slovenia

Department of Cardiology Medisch Spectrum Twente Thoraxcentrum Twente 7541 Enschede The Netherlands

Department of Cardiology National Heart Center Singapore 169609 Singapore

Department of Cardiology National University Hospital Singapore 119074 Singapore

Department of Cardiology Queen Elizabeth Hospital University of Hong Kong Hong Kong

Department of Cardiology Queen Mary Hospital University of Hong Kong Hong Kong

Department of Cardiology University Hospital Centre University of Zagreb 10000 Zagreb Croatia

Department of Clinical and Experimental Medicine University of Messina 98122 Messina Italy

Department of Heart and Vascular Surgery State Research Institute for Complex Issues of Cardiovascular Diseases 653002 Kemerovo Russia

Department of Internal Medicine Ospedale Riuniti 25121 Brescia Italy

Department of Statistical Sciences University of Padova 35121 Padova Italy

Department of Teaching and Research Instituto de Cardiología de Corrientes Juana F Cabral Corrientes W3400CDS Argentina

Division of Cardiology Alexandra Hospital 10431 Athens Greece

Division of Cardiology AOU Policlinico G Martino 98124 Messina Italy

Division of Cardiology Assiut University Heart Hospital Assiut University Asyut 71515 Egypt

Division of Cardiology Attikon University Hospital 10431 Athens Greece

Division of Cardiology AUSL IRCCS Reggio Emilia 42121 Reggio Emilia Italy

Division of Cardiology Azienda Ospedaliera Ospedali Riuniti Marche Nord 61121 Pesaro Italy

Division of Cardiology Blida University Hospital Blida 0900 Algeria

Division of Cardiology Bursa City Hospital 16110 Bursa Türkiye

Division of Cardiology Center Hospitalier Universitaire de Lille 59000 Lille France

Division of Cardiology CHU Lariboisière AP HP Paris 7 University INSERM UMRS 942 75010 Paris France

Division of Cardiology Clinica Villa dei Fiori 80011 Acerra Italy

Division of Cardiology Clinical and Experimental Interventional Cardiology University of Saarland 66421 Saarland Germany

Division of Cardiology Complejo Hospitalario de Toledo 45001 Toledo Spain

Division of Cardiology Faculty of Medicine Eskisehir Osmangazi University 02640 Eskisehir Türkiye

Division of Cardiology Galeazzi Sant'Ambrogio Hospital 20157 Milan Italy

Division of Cardiology Groupe Hospitalier Mutualiste de Grenoble 38000 Grenoble France

Division of Cardiology Heart Centre Turku 20521 Turku Finland

Division of Cardiology Hopital Erasmus Universitè Libre de Bruxelles 1050 Bruxelles Belgium

Division of Cardiology Hospital Cabueñes 33201 Gijon Spain

Division of Cardiology Hospital Clinico Universitario de Valencia 46010 Valencia Spain

Division of Cardiology Hospital Cordoba Cordoba 5000 Argentina

Division of Cardiology Hospital de Santa Cruz CHLO Nova Medical School 1000 Lisbon Portugal

Division of Cardiology Hospital de Santo António 4099 001 Porto Portugal

Division of Cardiology Hospital Puerta de Hierro Majadahonda 28222 Madrid Spain

Division of Cardiology Hospital Puerta del Mar 11001 Cadiz Spain

Division of Cardiology Hospital Universitario de Canarias 38001 Santa Cruz de Tenerife Spain

Division of Cardiology Kontantopoulion Hospital 10431 Athens Greece

Division of Cardiology Medical University of Silezia 40 002 Katowice Poland

Division of Cardiology Northwest Clinics 1811 Alkmaar The Netherlands

Division of Cardiology Odense Universitets Hospital 5000 Odense Denmark

Division of Cardiology Ospedale A Manzoni 23900 Lecco Italy

Division of Cardiology Ospedale Civico Arnas 90100 Palermo Italy

Division of Cardiology Ospedale degli Infermi ASL 13900 Biella Italy

Division of Cardiology Ospedale del Mare 80147 Napoli Italy

Division of Cardiology Ospedale F Spaziani 03100 Frosinone Italy

Division of Cardiology Ospedale G Moscati 81031 Aversa Italy

Division of Cardiology Ospedale Maggiore Bologna 40100 Bologna Italy

Division of Cardiology Ospedale S Maurizio 39100 Bolzano Italy

Division of Cardiology Ospedale San Giovanni di Dio e Ruggid'Aragona 84070 Salerno Italy

Division of Cardiology Ospedale Sant'Anna 44121 Ferrara Italy

Division of Cardiology Ospedale Santa Chiara di Trento 38014 Trento Italy

Division of Cardiology Ospedale Santa Maria delle Grazie 80078 Pozzuoli Italy

Division of Cardiology Ospedale Santa Maria Goretti Latina 04100 Latina Italy

Division of Cardiology Otamendi Hospital Buenos Aires 1001 Argentina

Division of Cardiology Oulu University Hospital 90220 Oulu Finland

Division of Cardiology Radboud University Medical Center 6525 Nijmegen The Netherlands

Division of Cardiology St Antonius Hospital 3434 Nieuwegein The Netherlands

Division of Cardiology UMC Utrecht 3584 Utrecht The Netherlands

Division of Cardiology Universidad UPB CES Medellin 050001 Colombia

Heart Center Siloam Lippo Village Hospital Cardiovascular Department Pelita Harapan University Tangerang 15810 Indonesia

Hospital Clínico Universitario Virgen de la Victoria 290000 Malaga Spain

Hospital Germans Triasi Pujol 8918 Badalona Spain

Instituto Cardiovascular de Buenos Aires 6302 Buenos Aires C1428 CABA Argentina

Instituto de Cardiologia de Santa Catarina Praia Comprida São José 88100 000 Brazil

Instituto de Cardiologia do Rio Grande do Sul Porto Alegre 90000 00 Brazil

Instituto de Cardiologia Integral Montevideo 11700 Uruguay

Interventional Cardiolgy Unit IRCCS INRCA 60131 Ancona Italy

Interventional Cardiology Unit Azienda Ospedaliera Sanitaria 43121 Parma Italy

Interventional Cardiology Unit Heart Disease Institute Hospital Universitari de Bellvitge 08016 Barcelona Spain

Invasive Cardiology and Congenital Heart Disease Patras University Hospital 26221 Patras Greece

Iraklion University Hospital 70001 Crete Greece

Maastricht University Medical Center 6229 HX Maastricht The Netherlands

Pronto de Socorro Cardiologico Prof Luis Tavares Centro PROCAPE Federal University of Pernambuco Recife 1235 Brazil

Tyumen Cardiology Research Center 625026 Tyumen Russia

University Clinic for Cardiology Medical Faculty Ss' Cyril and Methodius University 1000 Skopje North Macedonia

University Hospital Brno Medical Faculty of Masaryk University Brno 60200 Bohunice Czech Republic

University Hospital Prague 12808 Prague Czech Republic

Zobrazit více v PubMed

Li Q., Guan X., Wu P., Wang X., Zhou L., Tong Y., Ren R., Leung K.S.M., Lau E.H.Y., Wong J.Y., et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N. Engl. J. Med. 2020;26:1199–1207. doi: 10.1056/NEJMoa2001316. PubMed DOI PMC

Wood S. The Mystery of the Missing STEMIs during the COVID-19 Pandemic. tctMD: 2020. [(accessed on 24 June 2021)]. Available online: https://www.tctmd.com/news/mystery-missing-stemis-during-covid-19-pandemic.

Garcia S., Albaghdadi M.S., Meraj P.M., Schmidt C., Garberich R., Jaffer F.A., Dixon S., Rade J.J., Tannenbaum M., Chambers J., et al. Reduction in ST-Segment Elevation Cardiac Catheterization Laboratory Activations in the United States during COVID-19 Pandemic. J. Am. Coll. Cardiol. 2020;75:34913–34915. doi: 10.1016/j.jacc.2020.04.011. PubMed DOI PMC

Tam C.F., Cheung K.S., Lam S., Wong A., Yung A., Sze M., Lam Y.M., Chan C., Tsang T.C., Tsui M., et al. 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: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., et al. Population Trends in Rates of Percutaneous Coronary Revascularization for Acute Coronary Syndromes Associated with the COVID-19 Outbreak. Circulation. 2020;141:2035–2037. 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;141:1951–1953. doi: 10.1161/CIRCULATIONAHA.120.047523. PubMed DOI PMC

De Rosa S., Spaccarotella C., Basso C., Calabrò M.P., Curcio A., Filardi P.P., Mancone M., Mercuro G., Muscoli S., Nodari S., et al. 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;41:2083–2088. doi: 10.1093/eurheartj/ehaa409. PubMed DOI PMC

Xiang D., Xiang X., Zhang W., Yi S., Zhang J., Gu X., Xu Y., Huang K., Su X., Yu B., et al. Management and Outcomes of Patients with STEMI during the COVID-19 Pandemic in China. J. Am. Coll. Cardiol. 2020;76:1318–1324. doi: 10.1016/j.jacc.2020.06.039. PubMed DOI PMC

De Luca G., Verdoia M., Cercek M., Jensen L.O., Vavlukis M., Calmac L., Johnson T., Ferrer G.R., Ganyukov V., Wojakowski W., et al. Impact of COVID-19 Pandemic on Mechanical Reperfusion for Patients With STEMI. J. Am. Coll. Cardiol. 2020;76:2321–2330. doi: 10.1016/j.jacc.2020.09.546. PubMed DOI PMC

De Luca G., Cercek M., Jensen L.O., Vavlukis M., Calmac L., Johnson T., Roura I Ferrer G., Ganyukov V., Wojakowski W., von Birgelen C., et al. Impact of COVID-19 pandemic and diabetes on mechanical reperfusion in patients with STEMI: Insights from the ISACS STEMI COVID 19 Registry. Cardiovasc. Diabetol. 2020;19:215. doi: 10.1186/s12933-020-01196-0. PubMed DOI 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. doi: 10.1161/01.CIR.0000121424.76486.20. PubMed DOI

De Luca G., van’t Hof A.W., de Boer M.J., Ottervanger J.P., Hoorntje J.C., Gosselink A.T., Dambrink J.H., Zijlstra F. Suryapranata HTime-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

Ibanez B., James S., Agewall S., Antunes M.J., Bucciarelli-Ducci C., Bueno H., Caforio A.L.P., Crea F., Goudevenos J.A., Halvorsen S., et al. 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. Data Analysis Using Regression and Multilevel/Hierarchical Models. Cambridge University Press; New York, NY, USA: 2007.

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. doi: 10.1001/jamacardio.2020.1286. PubMed DOI

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. doi: 10.1111/jth.14817. PubMed DOI PMC

Baldi E., Sechi G.M., Mare C., Canevari F., Brancaglione A., Primi R., Klersy C., Palo A., Contri E., Ronchi V., et al. Lombardia CARe Researchers. Out-of-Hospital Cardiac Arrest during the COVID-19 Outbreak in Italy. N. Engl. J. Med. 2020;383:496–498. doi: 10.1056/NEJMc2010418. PubMed DOI PMC

De Luca G., van’t Hof A.W., Ottervanger J.P., Hoorntje J.C., Gosselink A.T., Dambrink J.H., de Boer M.J., Suryapranata H. Ageing, impaired myocardial perfusion, and mortality in patients with ST-segment elevation myocardial infarction treated by primary angioplasty. Eur. Heart J. 2005;26:662–666. doi: 10.1093/eurheartj/ehi110. PubMed DOI

De Luca G., van’t Hof A.W., Huber K., Gibson C.M., Bellandi F., Arntz H.R., Maioli M., Noc M., Zorman S., Secco G.G., et al. Impact of advanced age on myocardial perfusion, distal embolization, and mortality patients with ST-segment elevation myocardial infarction treated by primary angioplasty and glycoprotein IIb-IIIa inhibitors. Heart Vessel. 2014;29:15–20. doi: 10.1007/s00380-013-0323-4. PubMed DOI

Verdoia M., Pergolini P., Nardin M., Rolla R., Tonon F., Kedhi E., Suryapranata H., Carriero A., De Luca G. Novara Atherosclerosis Study Group (NAS). Impact of aging on platelet reactivity in diabetic patients receiving dual antiplatelet therapy. J. Thromb. Thrombolysis. 2019;48:413–421. doi: 10.1007/s11239-019-01873-2. PubMed DOI

Verdoia M., Pergolini P., Rolla R., Nardin M., Schaffer A., Barbieri L., Marino P., Bellomo G., Suryapranata H., De Luca G. Advanced age and high-residual platelet reactivity in patients receiving dual antiplatelet therapy with clopidogrel or ticagrelor. J. Thromb. Haemost. 2016;14:57–64. doi: 10.1111/jth.13177. PubMed DOI

Silverio A., Di Maio M., Citro R., Esposito L., Iuliano G., Bellino M., Baldi C., De Luca G., Ciccarelli M., Vecchione C., et al. Cardiovascular risk factors and mortality in hospitalized patients with COVID-19: Systematic review and meta-analysis of 45 studies and 18,300 patients. BMC Cardiovasc. Disord. 2021;21:23. doi: 10.1186/s12872-020-01816-3. PubMed DOI PMC

Stefanini G.G., Montorfano M., Trabattoni D., Andreini D., Ferrante G., Ancona M., Metra M., Curello S., Maffeo D., Pero G., et al. ST-Elevation Myocardial Infarctionin Patients with COVID-19: Clinical and Angiographic Outcomes. Circulation. 2020;141:2113–2116. doi: 10.1161/CIRCULATIONAHA.120.047525. PubMed DOI PMC

Marijon E., Karam N., Jost D., Perrot D., Frattini B., Derkenne C., Sharifzadehgan A., Waldmann V., Beganton F., Narayanan K., et al. 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. doi: 10.1016/S2468-2667(20)30117-1. PubMed DOI PMC