Age-Related Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI: Results of the ISACS-STEMI COVID-19 Registry

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 pandem...

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Autores: De Luca, G, Algowhary, M, Uguz, B, Oliveira, DC, Ganyukov, V, Busljetik, O, Cercek, M, Jensen, LO, Loh, PH, Calmac, L, Ferrer, GRI, Quadros, A, Milewski, M, D'Uccio, FS, von Birgelen, C, Versaci, F, Ten Berg, J, Casella, G, Lung, AWS, Kala, P, Gil, JLD, Carrillo, X, Dirksen, M, Munoz, V, Lee, MKY, Juzar, DA, Joaquim, RD, Paladino, R, Milicic, D, Davlouros, P, Bakraceski, N, Zilio, F, Donazzan, L, Kraaijeveld, A, Galasso, G, Arpad, L, Marinucci, L, Guiducci, V, Menichelli, M, Scoccia, A, Yamac, AH, Mert, KU, Rios, XF, Kovarnik, T, Kidawa, M, Moreu, J, Flavien, V, Fabris, E, Martinez-Luengas, IL, Boccalatte, M, Ojeda, F, Arellano-Serrano, C, Caiazzo, G, Cirrincione, G, Kao, HL, Fores, JS, Vignali, L, Pereira, H, Manzo-Silberman, S, Ordonez, S, Ozkan, AA, Scheller, B, Lehitola, H, Teles, R, Mantis, C, Antti, Y, Silveira, JAB, Zoni, CR, Bessonov, I, Uccello, G, Kochiadakis, G, Alexopulos, D, Uribe, CE, Kanakakis, J, Faurie, B, Gabrielli, G, Barrios, AG, Bachini, JP, Rocha, A, Tam, FCC, Rodriguez, A, Lukito, AA, Saint-Joy, V, Pessah, G, Tuccillo, A, Ielasi, A, Cortese, G, Parodi, G, Burgadha, MA, Kedhi, E, Lamelas, P, Suryapranata, H, Nardin, M, Verdoia, M
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Institución:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p17536
Acceso en línea:https://incliva.portalinvestigacion.com/publicaciones/17536
Access Level:acceso abierto
Palabra clave:ageing
ST-segment elevation myocardial infarction
COVID-19
Descripción
Sumario: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.

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