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

Abstract

ObjectiveThe 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).MethodsThis 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.ResultsIn 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 door-to-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.ConclusionPercutaneous 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.Trial registration numberNCT04412655.

Angiographic and clinical outcome of SARS-CoV-2 positive patients with ST-segment elevation myocardial infarction undergoing primary angioplasty: A collaborative, individual patient data meta-analysis of six registry-based studies

“…Our control group consisted of SARS-CoV-2 negative STEMI patients undergoing PPCI enrolled from March to June 2020 in the ISACS-STEMI COVID 19 registry [8] .…”

“…Coronavirus disease 2019 (COVID-19) has strongly impacted on worldwide healthcare systems with significant resources diverted to deal with this unforeseeable modern pandemic. Several reports have described an increased cardiovascular mortality during the COVID-19 pandemic due to direct [ 1 , 2 ] and indirect effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection [3] , [4] , [5] , [6] , [7] , [8] . COVID-19 may induce oxygen supply/demand imbalance, abnormal systemic inflammatory response, atherosclerotic plaque rupture, overactivation of the coagulation system, and platelet hyperreactivity [ 1 , 2 ].…”

“…The indirect consequences of the COVID-19 pandemic included social distancing, the fear of the contagion and the prominent media attention on the uncontrolled spread of the disease, which refrained patients from activating the emergency system or doing so, but with considerable delay. The redistribution of healthcare resources affected the local emergency networks and contributed to treatment delays [7] , [8] , [9] , [10] .…”

The STEMI phenomenon during the COVID-19 pandemic: what is beneath the tip of the iceberg?

“…De Luca and colleagues6 now report in the journal a follow-up study and the final results of the ISACS-STEMI COVID-19 Registry in which they have re-examined the incidence rates of patients with STEMI undergoing PPCI, delayed treatment (defined as ischaemia time over 12 hours and door-to-balloon time over 30 min) along with in-hospital mortality and short-term mortality (ie, within 30 days). The study cohort included a total of 16 674 patients from 109 sites in Europe, Latin-America, Southeast Asia and North-Africa.…”

Heartbeat: delayed and inadequate treatment of acute coronary syndromes during the COVID-19 pandemic

“…The early phase of the COVID-19 pandemic was associated with fewer patients receiving primary percutaneous coronary intervention (PPCI) and a higher hospital mortality for acute myocardial infarction in Europe. In this issue of Heart , De Luca and colleagues1 report the final results of the International Study on Acute Coronary Syndromes—ST Elevation Myocardial Infarction (ISACS-STEMI) Registry which included over 16 thousand patients presenting March to June 2020 at 109 high-volume PPCI centres in Europe, Latin America, South-East Asia and North Africa. Overall, there was a lower rate of PPCI in 2020 compared with 2019 with marked geographical heterogeneity; but no association between PPCI volumes and peak COVID-19 case or mortality rates (figure 1).…”