Impact of diabetes on epicardial reperfusion and mortality in a contemporary STEMI population undergoing mechanical reperfusion: Insights from the ISACS STEMI COVID 19 registry

. 2025 May ; 35 (5) : 103763. [epub] 20241024

Jazyk angličtina Země Nizozemsko Médium print-electronic

Typ dokumentu časopisecké články, multicentrická studie

Perzistentní odkaz   https://www.medvik.cz/link/pmid39638679
Odkazy

PubMed 39638679
DOI 10.1016/j.numecd.2024.09.031
PII: S0939-4753(24)00382-X
Knihovny.cz E-zdroje

BACKGROUND AND AIM: Diabetes has been shown in last decades to be associated with a significantly higher mortality among patients with ST-segment elevation myocardial infarction (STEMI) treated with primary PCI (PPCI). Therefore, the aim of current study was to evaluate the impact of diabetes on times delays, reperfusion and mortality in a contemporary STEMI population undergoing PPCI, including treatment during the COVID pandemic. METHODS AND RESULTS: The ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry involving PPCI centers from Europe, Latin America, South-East Asia and North-Africa, including patients treated from 1st of March until June 30, 2019 and 2020. Primary study endpoint of this analysis was in-hospital mortality. Secondary endpoints were postprocedural TIMI 0-2 flow and 30-day mortality. Our population is represented by 16083 STEMI patients. A total of 3812 (23,7 %) patients suffered from diabetes. They were older, more often males as compared to non-diabetes. Diabetic patients were less often active smokers and had less often a positive family history of CAD, but they were more often affected by hypertension and hypercholesterolemia, with higher prevalence of previous STEMI and previous CABG. Diabetic patients had longer ischemia time, had more often anterior MI, cardiogenic shock, rescue PCI and multivessel disease. They had less often out-of-hospital cardiac arrest and in-stent thrombosis, received more often a mechanical support, received less often a coronary stent and DES. Diabetes was associated with a significantly impaired postprocedural TIMI flow (TIMI 0-2: 9.8 % vs 7.2 %, adjusted OR [95 % CI] = 1.17 [1.02-1.38], p = 0.024) and higher mortality (in-hospital: 9.1 % vs 4.8 %, Adjusted OR [95 % CI] = 1.70 [1.43-2.02], p < 0.001; 30-day mortality: 10.8 % vs 6 %, Adjusted HR [95 % CI] = 1.46 [1.26-1.68], p < 0.001) as compared to non-diabetes, particularly during the pandemic. CONCLUSIONS: Our study showed that in a contemporary STEMI population undergoing PPCI, diabetes is significantly associated with impaired epicardial reperfusion that translates into higher in-hospital and 30-day mortality, particularly during the pandemic.

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 Instanbul University Instanbul 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 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 Indonesia

Department of Cardiology Hospital Bezmialem Vakıf University İstanbul Turkey

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 Internal Medicine Ospedale Riuniti Brescia Italy

Department of Statistical Sciences University of Padova Italy

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 Department of Clinical and Experimental Medicine University of Messina Messina Italy; Division of Cardiology IRCSS Galeazzi Sant'Ambrogio Hospital Milan Italy

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 Italy

Division of Cardiology Azienda Ospedaliera Ospedali Riuniti Marche Nord Pesaro Italy

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 Complejo Hospitalario de Toledo Toledo Spain

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 Belgium

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 Spain

Division of Cardiology Kontantopoulion 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 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 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 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

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 Brazil

Instituto de Cardiologia Integral Montevideo Uruguay

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

Iraklion University Hospital Crete 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 Macedonia

University Hospital Brno Medical Faculty of Masaryk University Brno Czech Republic

University Hospital Prague Czech Republic

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