Impact of COVID-19 Pandemic on Mechanical Reperfusion for Patients With STEMI.

Abstract

BACKGROUND:

The fear of contagion during the coronavirus disease-2019 (COVID-19) pandemic may have potentially refrained patients with ST-segment elevation myocardial infarction (STEMI) from accessing the emergency system, with subsequent impact on mortality.

OBJECTIVES:

The ISACS-STEMI COVID-19 registry aims to estimate the true impact of the COVID-19 pandemic on the treatment and outcome of patients with STEMI treated by primary percutaneous coronary intervention (PPCI), with identification of "at-risk" patient cohorts for failure to present or delays to treatment.

METHODS:

This retrospective registry was performed in European high-volume PPCI centers and assessed patients with STEMI treated with PPPCI in March/April 2019 and 2020. Main outcomes are the incidences of PPCI, delayed treatment, and in-hospital mortality.

RESULTS:

A total of 6,609 patients underwent PPCI in 77 centers, located in 18 countries. In 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio: 0.811; 95% confidence interval: 0.78 to 0.84; p < 0.0001). The heterogeneity among centers was not related to the incidence of death due to COVID-19. A significant interaction was observed for patients with arterial hypertension, who were less frequently admitted in 2020 than in 2019. Furthermore, the pandemic was associated with a significant increase in door-to-balloon and total ischemia times, which may have contributed to the higher mortality during the pandemic.

CONCLUSIONS:

The COVID-19 pandemic had significant impact on the treatment of patients with STEMI, with a 19% reduction in PPCI procedures, especially among patients suffering from hypertension, and a longer delay to treatment, which may have contributed to the increased mortality during the pandemic. (Primary Angioplasty for STEMI During COVID-19 Pandemic [ISACS-STEMI COVID-19] Registry; NCT04412655).

• Authors: Giuseppe De Luca, Monica Verdoia, Miha Cercek, Lisette Okkels Jensen, Marija Vavlukis, Lucian Calmac, Tom Johnson, Gerard Rourai Ferrer, Vladimir Ganyukov, Wojtek Wojakowski, Tim Kinnaird, Clemens van Birgelen, Yves Cottin, Alexander IJsselmuiden, Bernardo Tuccillo, Francesco Versaci, Kees-Jan Royaards, Jurrien Ten Berg, Mika Laine, Maurits Dirksen, Massimo Siviglia, Gianni Casella, Petr Kala, José Luis Díez Gil, Adrian Banning, Victor Becerra, Ciro De Simone, Andrea Santucci, Xavier Carrillo, Alessandra Scoccia, Giovanni Amoroso, Arpad Lux, Tomas Kovarnik, Periklis Davlouros, Julinda Mehilli, Gabriele Gabrielli, Xacobe Flores Rios, Nikola Bakraceski, Sébastien Levesque, Giuseppe Cirrincione, Vincenzo Guiducci, Michał Kidawa, Leonardo Spedicato, Lucia Marinucci, Peter Ludman, Filippo Zilio, Gennaro Galasso, Enrico Fabris, Maurizio Menichelli, Arturo Garcia-Touchard, Stephane Manzo, Gianluca Caiazzo, Jose Moreu, Juan Sanchis Forés, Luca Donazzan, Luigi Vignali, Rui Teles, Edouard Benit, Pierfrancesco Agostoni, Francisco Bosa Ojeda, Heidi Lehtola, Santiago Camacho-Freiere, Adriaan Kraaijeveld, Ylitalo Antti, Marco Boccalatte, Pierre Deharo, Iñigo Lozano Martínez-Luengas, Bruno Scheller, Dimitrios Alexopoulos, Raul Moreno, Elvin Kedhi, Giuseppe Uccello, Benjamin Faurie, Alejandro Gutierrez Barrios, Fortunato Scotto Di Uccio, Bor Wilbert, Pieter Smits, Giuliana Cortese, Guido Parodi, Dariusz Dudek
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 76 Issue 20 Pg. 2321-2330 (11 17 2020) ISSN: 1558-3597 [Electronic] United States
• PMID: 33183506 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• COVID-19
• Coronavirus Infections
• Europe (epidemiology)
• Female
• Humans
• Male
• Middle Aged
• Pandemics
• Percutaneous Coronary Intervention (statistics & numerical data)
• Pneumonia, Viral
• Registries
• Retrospective Studies
• ST Elevation Myocardial Infarction (mortality, therapy)