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Multicenter Study
. 2020 Nov 17;76(20):2321-2330.
doi: 10.1016/j.jacc.2020.09.546.

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

Giuseppe De Luca  1 , Monica Verdoia  2 , Miha Cercek  3 , Lisette Okkels Jensen  4 , Marija Vavlukis  5 , Lucian Calmac  6 , Tom Johnson  7 , Gerard Rourai Ferrer  8 , Vladimir Ganyukov  9 , Wojtek Wojakowski  10 , Tim Kinnaird  11 , Clemens van Birgelen  12 , Yves Cottin  13 , Alexander IJsselmuiden  14 , Bernardo Tuccillo  15 , Francesco Versaci  16 , Kees-Jan Royaards  17 , Jurrien Ten Berg  18 , Mika Laine  19 , Maurits Dirksen  20 , Massimo Siviglia  21 , Gianni Casella  22 , Petr Kala  23 , José Luis Díez Gil  24 , Adrian Banning  25 , Victor Becerra  26 , Ciro De Simone  27 , Andrea Santucci  28 , Xavier Carrillo  29 , Alessandra Scoccia  30 , Giovanni Amoroso  31 , Arpad Lux  32 , Tomas Kovarnik  33 , Periklis Davlouros  34 , Julinda Mehilli  35 , Gabriele Gabrielli  36 , Xacobe Flores Rios  37 , Nikola Bakraceski  38 , Sébastien Levesque  39 , Giuseppe Cirrincione  40 , Vincenzo Guiducci  41 , Michał Kidawa  42 , Leonardo Spedicato  43 , Lucia Marinucci  44 , Peter Ludman  45 , Filippo Zilio  46 , Gennaro Galasso  47 , Enrico Fabris  48 , Maurizio Menichelli  49 , Arturo Garcia-Touchard  50 , Stephane Manzo  51 , Gianluca Caiazzo  52 , Jose Moreu  53 , Juan Sanchis Forés  54 , Luca Donazzan  55 , Luigi Vignali  56 , Rui Teles  57 , Edouard Benit  58 , Pierfrancesco Agostoni  59 , Francisco Bosa Ojeda  60 , Heidi Lehtola  61 , Santiago Camacho-Freiere  62 , Adriaan Kraaijeveld  63 , Ylitalo Antti  64 , Marco Boccalatte  65 , Pierre Deharo  66 , Iñigo Lozano Martínez-Luengas  67 , Bruno Scheller  68 , Dimitrios Alexopoulos  69 , Raul Moreno  70 , Elvin Kedhi  71 , Giuseppe Uccello  72 , Benjamin Faurie  73 , Alejandro Gutierrez Barrios  74 , Fortunato Scotto Di Uccio  15 , Bor Wilbert  18 , Pieter Smits  17 , Giuliana Cortese  75 , Guido Parodi  76 , Dariusz Dudek  77
Affiliations
Multicenter Study

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

Giuseppe De Luca et al. J Am Coll Cardiol. .

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).

Keywords: COVID-19; STEMI; primary angioplasty.

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Conflict of interest statement

Author Relationship With Industry This study was promoted by the Eastern Piedmont University, Novara, Italy, without any financial support. Dr. Cortese has been funded by PRIN2017 (20178S4EK9). All authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Central Illustration
Central Illustration
Impact of Coronavirus Disease-2019 Pandemic Primary Percutaneous Coronary Intervention Cases, on Time Delays and Mortality Box-and-whisker plot showing the number of patients with STEMI treated by mechanical reperfusion per million of inhabitants/year in 2019 and 2020 in the overall population (A) and according to hypertension, the only clinical variable significantly affecting the number of cases (B). Bar graphs show the association between the year of intervention with time delays (ischemia time longer than 12 h, left graph) and door-to-balloon time longer than 30 min, right graph(C). Bar graphs show the association between the year of intervention with in-hospital mortality with (left graph) and without (right graph) COVID-positive patients (D). CI = confidence interval; COVID-19 = coronavirus-2019; IRR = incidence rate ratio; PCI = percutaneous coronary intervention; STEMI = ST-segment elevation myocardial intervention.
Figure 1
Figure 1
Impact of COVID-19 Pandemic on Mechanical Reperfusion for STEMI Forest plot of the incidence rate ratio on the log-scaled axis, with 95% confidence interval, across each hospital center. COVID-19 = coronavirus disease-2019; PCI = percutaneous coronary intervention; STEMI = ST-segment elevation myocardial infarction.
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