TY - JOUR
T1 - Age-Related Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI: Results of the ISACS-STEMI COVID-19 Registry
AU - De Luca, Giuseppe
AU - Algowhary, Magdy
AU - Uguz, Berat
AU - Oliveira, Dinaldo C.
AU - Ganyukov, Vladimir
AU - Busljetik, Oliver
AU - Cercek, Miha
AU - Jensen, Lisette Okkels
AU - Loh, Poay Huan
AU - Calmac, Lucian
AU - Ferrer, Gerard Roura i
AU - Quadros, Alexandre
AU - Milewski, Marek
AU - D'Uccio, Fortunato Scotto
AU - von Birgelen, Clemens
AU - Versaci, Francesco
AU - Ten Berg, Jurrien
AU - Casella, Gianni
AU - Lung, Aaron Wong Sung
AU - Kala, Petr
AU - Gil, Jose Luis Diez
AU - Carrillo, Xavier
AU - Dirksen, Maurits
AU - Munoz, Victor Becerra
AU - Lee, Michael Kang-yin
AU - Juzar, Dafsah Arifa
AU - Joaquim, Rodrigo de Joaquim
AU - Paladino, Roberto
AU - Milicic, Davor
AU - Davlouros, Periklis
AU - Bakraceski, Nikola
AU - Zilio, Filippo
AU - Donazzan, Luca
AU - Kraaijeveld, Adriaan
AU - Galasso, Gennaro
AU - Arpad, Lux
AU - Marinucci, Lucia
AU - Guiducci, Vincenzo
AU - Menichelli, Maurizio
AU - Scoccia, Alessandra
AU - Yamac, Aylin Hatice
AU - Mert, Kadir Ugur
AU - Rios, Xacobe Flores
AU - Kovarnik, Tomas
AU - Kidawa, Michal
AU - Moreu, Jose
AU - Flavien, Vincent
AU - Fabris, Enrico
AU - Martinez-Luengas, Inigo Lozano
AU - Boccalatte, Marco
PY - 2023/3/1
Y1 - 2023/3/1
N2 - 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.
AB - 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.
KW - ageing
KW - ST-segment elevation myocardial infarction
KW - COVID-19
KW - ACUTE MYOCARDIAL-INFARCTION
KW - ST-SEGMENT ELEVATION
KW - PRIMARY ANGIOPLASTY
KW - MANAGEMENT
KW - PERFUSION
KW - IMPACT
U2 - 10.3390/jcm12062116
DO - 10.3390/jcm12062116
M3 - Article
C2 - 36983119
SN - 2077-0383
VL - 12
JO - Journal of Clinical Medicine
JF - Journal of Clinical Medicine
IS - 6
M1 - 2116
ER -