COVID-19 pandemic, mechanical reperfusion and 30-day mortality in ST elevation myocardial infarction

Authors	DE LUCA G. ALGOWHARY M. UGUZ B. OLIVEIRA D. C. GANYUKOV V. ZIMBAKOV Z. CERCEK M. JENSEN L. O. LOH P.H . CALMAC L. ROURA-FERRER G. QUADROS A. MILEWSKI M. SCOTTO DI UCCIO F. VON BIRGELEN C. VERSACI F. TEN BERG J. CASELLA G. WONG A. S. L. KALA Petr DIEZ GIL J. L. CARRILLO X. DIRKSEN M. T. BECERRA-MUNOZ VM. KANG-YIN LEE M. JUZAR D. A. DE MOURA JOAQUIM R. PALADINO R. MILICIC D. DAVLOUROS P. BAKRACESKI N. ZILIO F. DONAZZAN L. KRAAIJEVELD A. O. GALASSO G. LUX A. MARINUCCI L. GUIDUCCI V. MENICHELLI M. SCOCCIA A. YAMAC A. UGUR MERT K. FLORES RIOS X. KOVARNIK T. KIDAWA M. MOREU J. FLAVIEN V. FABRIS E. LOZANO MARTINEZ-LUENGAS I. BOCCALATTE M. BOSA OJEDA F. ARELLANO-SERRANO C. CAIAZZO G. CIRRINCIONE G. KAO H. L. SANCHIS FORES J. VIGNALI L. PEREIRA H. MANZO-SILBERMAN S. ORDONEZ S. ÖZKAN A. A. SCHELLER B. LEHTOLA H. TELES R. MANTIS C. YLITALO A. BRUM SILVEIRA J. A. ZONI R. BESSONOV I. SAVONITTO S. KOCHIADAKIS G. ALEXOPOULOS D. URIBE C. KANAKAKIS J. FAURIE B. GABRIELLI G. GUTIÉRREZ A. BACHINI J. P. ROCHA A. TAM F. C. RODRIGUEZ A. LUKITO A. SAINT-JOY V. PESSAH G. TUCCILLO B. CORTESE G. PARODI G. BOURAGHDA M. A. KEDHI E. LAMELAS P. SURYAPRANATA H. NARDIN M. VERDOIA M.
Year of publication	2022
Type	Article in Periodical
Magazine / Source	Heart
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://heart.bmj.com/content/early/2021/10/27/heartjnl-2021-319750
Doi	http://dx.doi.org/10.1136/heartjnl-2021-319750
Keywords	COVID-19; mechanical reperfusion; ST elevation myocardial infarction
Description	Objective The initial data of the International Study on Acute Coronary Syndromes - ST Elevation Myocardial Infarction COVID-19 showed in Europe a remarkable reduction in primary percutaneous coronary intervention procedures and higher in-hospital mortality during the initial phase of the pandemic as compared with the prepandemic period. The aim of the current study was to provide the final results of the registry, subsequently extended outside Europe with a larger inclusion period (up to June 2020) and longer follow-up (up to 30 days). Methods This is a retrospective multicentre registry in 109 high-volume primary percutaneous coronary intervention (PPCI) centres from Europe, Latin America, South-East Asia and North Africa, enrolling 16 674 patients with ST segment elevation myocardial infarction (STEMI) undergoing PPPCI in March/June 2019 and 2020. The main study outcomes were the incidence of PPCI, delayed treatment (ischaemia time >12 hours and door-to-balloon >30 min), in-hospital and 30-day mortality. Results In 2020, during the pandemic there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio 0.843, 95% CI 0.825 to 0.861, p<0.0001). This reduction was significantly associated with age, being higher in older adults (>75 years) (p=0.015), and was not related to the peak of cases or deaths due to COVID-19. The heterogeneity among centres was high (p<0.001). Furthermore, the pandemic was associated with a significant increase in doorto-balloon time (40 (25-70) min vs 40 (25-64) min, p=0.01) and total ischaemia time (225 (135-410) min vs 196 (120-355) min, p<0.001), which may have contributed to the higher in-hospital (6.5% vs 5.3%, p<0.001) and 30-day (8% vs 6.5%, p=0.001) mortality observed during the pandemic. Conclusion Percutaneous revascularisation for STEMI was significantly affected by the COVID-19 pandemic, with a 16% reduction in PPCI procedures, especially among older patients (about 20%), and longer delays to treatment, which may have contributed to the increased in-hospital and 30-day mortality during the pandemic.