BACKGROUND: Hypertension is the most prevalent cardiovascular risk factor, with several detrimental effects on the cardiovascular system. Contrasting results have been reported so far on its prognostic role in patients admitted for ST-segment elevation myocardial infarction (STEMI). Therefore, we investigated the impact of hypertension on short-term mortality in a large multicenter contemporary registry of STEMI patients, including patients treated during COVID-19 pandemic. METHODS: The ISACS-STEMI COVID-19 was a retrospective registry that included STEMI patients treated with primary percutaneous coronary intervention (PCI) between March and June of 2019 and 2020 in 109 high-volume primary PCI centers from 4 continents. We collected data on baseline, clinical and procedural characteristics, in-hospital outcome and 30-day mortality. For this analysis patients were grouped according to history of hypertension at admission. RESULTS: A total of 16083 patients were assessed, including 8813 (54.8%) with history of hypertension. These patients were more often elderly, with a worse cardiovascular risk profile, but were less frequently active smoker. Some procedural differences were observed between the two groups, including lower rate of thrombectomy and use of glycoprotein IIb/IIIa inhibitors or cangrelor but more extensive coronary disease in patients with hypertension. Between patients with and without hypertension, there was no significant difference in SARS-CoV-2 positivity. Hypertensive patients had a significantly higher in-hospital and 30-day mortality, similarly observed in both pre-COVID-19 and COVID-19 era, and confirmed after adjustment for main baseline differences and propensity score (in-hospital mortality: adjusted odds ratio (OR) [95% confidence interval (CI)] =1.673 [1.389-2.014], P < 0.001; 30-day mortality: adjusted hazard ratio (HR) [95% CI] = 1.418 [1.230-1.636], P < 0.001). CONCLUSION: This is one of the largest and contemporary study assessing the impact of hypertension in STEMI patients undergoing primary angioplasty, including also the COVID-19 pandemic period. Hypertension was independently associated with significantly higher rates of in-hospital and 30-day mortality.

Azienda Ospedaliero Universitaria Ospedali Riuniti Trieste Italy

Azienda Ospedaliero Universitaria Sassari Italy

Cardiology Division Department of Internal Medicine National Taiwan University Hospital Tapei Taiwan

Cardiology Institute Istanbul University Istanbul Turkey

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

Carlos E Uribe Division of Cardiology Universidad UPB Universidad CES Medellin Colombia

Center for Cardiovascular Diseases Ohrid North Macedonia

Center Hospitalier d'Antibes Juan Les Pins Antibes 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 and Cardiovascular Interventions Instituto Nacional de Cirugía Cardíaca Montevideo Uruguay

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

Department of Cardiology Hospital Bezmialem Vakif University İstanbul

Department of Cardiology Medisch Spectrum Twente Thoraxcentrum Twente Enschede The Netherlands

Department of Cardiology National Heart Center Singapore

Department of Cardiology National University Hospital 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 Zagreb Croatia

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

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

Division of Cardiology Alexandra Hospital Athens Greece

Division of Cardiology AOU Policlinico G Martino University of Messina Messina Italy and Division of Cardiology IRCCS Hospital Galeazzi Sant'Ambrogio Milan

Division of Cardiology Assiut University Heart Hospital Assiut University Asyut Egypt

Division of Cardiology Attikon University Hospital Athens Greece

Division of Cardiology AUSL IRCCS Reggio Emilia

Division of Cardiology Azienda Ospedaliera Ospedali Riuniti Marche Nord Pesaro

Division of cardiology Blida University Hospital Blida Algeria

Division of Cardiology Bursa City Hospital Bursa Turkey

Division of Cardiology Center Hospitalier Universitaire de Lille Lille France

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 ComplejoHospitalario de Toledo Toledo Spa in

Division of Cardiology Eskisehir Osmangazi University Faculty of Medicine Eskisehir Turkey

Division of Cardiology Groupe Hospitalier Mutualiste de Grenoble France

Division of Cardiology Heart Centre Turku Finland

Division of Cardiology Hopital Erasmus Universitè Libre de Bruxelles

Division of Cardiology Hospiatl Cordoba Cordoba Argentina

Division of Cardiology Hospital Cabueñes Gijon Spain

Division of Cardiology Hospital Clinico Universitario de Valencia Spain

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

Division of Cardiology Hospital de Santo António Porto Portugal

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

Division of Cardiology Konstantopoulion Hospital Athens Greece

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 Italy

Division of Cardiology Ospedale F Spaziani Frosinone

Division of Cardiology Ospedale G Moscati Aversa

Division of Cardiology Ospedale Maggiore Bologna Italy

Division of Cardiology Ospedale S Giovanni Bosco Napoli Italy

Division of Cardiology 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 Chiara di Trento

Division of Cardiology Ospedale Santa Maria delle Grazie Pozzuoli Italy

Division of Cardiology Ospedale Santa Maria Goretti Latina Italy

Division of Cardiology Otamendi Hospital Buenos Aires Argentina

Division of Cardiology Oulu University Hospital Finland

Division of Cardiology Radboud University Medical Center Nijmegen The Netherlands

Division of Cardiology St Antonius Hospital Nieuwegein The Netherlands

Division of Cardiology UMC Utrecht The Netherlands

H Universitario y Politécnico La Fe Valencia Spain

Heraklion University Hospital Crete Greece

Hospital Clínico Universitario Virgen de la Victoria Málaga Spain

Hospital Garcia de Orta Cardiology Department Pragal Almada Portugal

Hospital Germans Triasi Pujol Badalona Spain

Instituto Cardiovascular de Buenos Aires Buenos Aires Argentina

Instituto de Cardiologia de Santa Catarina Praia Comprida São José Brazil

Instituto de Cardiologia do Rio Grande do Sul Porto Alegre

Instituto de Cardiologia Integral Montevideo Uruguay

Internal Medicine Department of Medicine ASST Spedali Civili Brescia Italy

Interventional Cardiolgy Unit IRCCS INRCA Ancona Italy

Interventional Cardiology Unit Azienda Ospedaliera Sanitaria Parma 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

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

Tyumen Cardiology Research Center Russia

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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