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. 2021 Oct-Dec:4:100022.
doi: 10.1016/j.deman.2021.100022. Epub 2021 Oct 30.

Renin-angiotensin system inhibitors and mortality among diabetic patients with STEMI undergoing mechanical reperfusion during the COVID-19 pandemic

Giuseppe De Luca  1 , Matteo Nardin  2 , Magdy Algowhary  3 , Berat Uguz  4 , Dinaldo C Oliveira  5 , Vladimir Ganyukov  6 , Zan Zimbakov  7 , Miha Cercek  8 , Lisette Okkels Jensen  9 , Poay Huan Loh  10 , Lucian Calmac  11 , Gerard Roura Ferrer  12 , Alexandre Quadros  13 , Marek Milewski  14 , Fortunato Scotto di Uccio  15 , Clemens von Birgelen  16 , Francesco Versaci  17 , Jurrien Ten Berg  18 , Gianni Casella  19 , Aaron Wong Sung Lung  20 , Petr Kala  21 , José Luis Díez Gil  22 , Xavier Carrillo  23 , Maurits Dirksen  24 , Victor M Becerra-Munoz  25 , Michael Kang-Yin Lee  26 , Dafsah Arifa Juzar  27 , Rodrigo de Moura Joaquim  28 , Roberto Paladino  29 , Davor Milicic  30 , Periklis Davlouros  31 , Nikola Bakraceski  32 , Filippo Zilio  33 , Luca Donazzan  34 , Adriaan Kraaijeveld  35 , Gennaro Galasso  36 , Arpad Lux  37 , Lucia Marinucci  38 , Vincenzo Guiducci  39 , Maurizio Menichelli  40 , Alessandra Scoccia  41 , Aylin Hatice Yamac  42 , Kadir Ugur Mert  43 , Xacobe Flores Rios  44 , Tomas Kovarnik  45 , Michal Kidawa  46 , Josè Moreu  47 , Vincent Flavien  48 , Enrico Fabris  49 , Iñigo Lozano Martínez-Luengas  50 , Marco Boccalatte  51 , Francisco Bosa Ojeda  52 , Carlos Arellano-Serrano  53 , Gianluca Caiazzo  54 , Giuseppe Cirrincione  55 , Hsien-Li Kao  56 , Juan Sanchis Forés  57 , Luigi Vignali  58 , Helder Pereira  59 , Stephane Manzo  60 , Santiago Ordoñez  61 , Alev Arat Özkan  62 , Bruno Scheller  63 , Heidi Lehtola  64 , Rui Teles  65 , Christos Mantis  66 , Ylitalo Antti  67 , João António Brum Silveira  68 , Rodrigo Zoni  69 , Ivan Bessonov  70 , Stefano Savonitto  71 , George Kochiadakis  72 , Dimitrios Alexopulos  73 , Carlos E Uribe  74 , John Kanakakis  75 , Benjamin Faurie  76 , Gabriele Gabrielli  77 , Alejandro Gutierrez Barrios  78 , Juan Pablo Bachini  79 , Alex Rocha  80 , Frankie Chor-Cheung Tam  81 , Alfredo Rodriguez  82 , Antonia Anna Lukito  83 , Veauthyelau Saint-Joy  84 , Gustavo Pessah  85 , Andrea Tuccillo  15 , Giuliana Cortese  86 , Guido Parodi  87 , Mohammed Abed Bouraghda  88 , Elvin Kedhi  89 , Pablo Lamelas  90 , Harry Suryapranata  91 , Monica Verdoia  91
Affiliations

Renin-angiotensin system inhibitors and mortality among diabetic patients with STEMI undergoing mechanical reperfusion during the COVID-19 pandemic

Giuseppe De Luca et al. Diabet Epidemiol Manag. 2021 Oct-Dec.

Abstract

Background: During the coronavirus disease 2019 (COVID-19) pandemic, concerns have been arisen on the use of renin-angiotensin system inhibitors (RASI) due to the potentially increased expression of Angiotensin-converting-enzyme (ACE)2 and patient's susceptibility to SARS-CoV2 infection. Diabetes mellitus have been recognized favoring the coronavirus infection with consequent increase mortality in COVID-19. No data have been so far reported in diabetic patients suffering from ST-elevation myocardial infarction (STEMI), a very high-risk population deserving of RASI treatment.

Methods: The ISACS-STEMI COVID-19 registry retrospectively assessed STEMI patients treated with primary percutaneous coronary intervention (PPCI) in March/June 2019 and 2020 in 109 European high-volume primary PCI centers. This subanalysis assessed the prognostic impact of chronic RASI therapy at admission on mortality and SARS-CoV2 infection among diabetic patients.

Results: Our population is represented by 3812 diabetic STEMI patients undergoing mechanical reperfusion, 2038 in 2019 and 1774 in 2020. Among 3761 patients with available data on chronic RASI therapy, between those ones with and without treatment there were several differences in baseline characteristics, (similar in both periods) but no difference in the prevalence of SARS-CoV2 infection (1.6% vs 1.3%, respectively, p = 0.786). Considering in-hospital medication, RASI therapy was overall associated with a significantly lower in-hospital mortality (3.3% vs 15.8%, p < 0.0001), consistently both in 2019 and in 2010.

Conclusions: This is first study to investigate the impact of RASI therapy on prognosis and SARS-CoV2 infection of diabetic patients experiencing STEMI and undergoing PPCI during the COVID-19 pandemic. Both pre-admission chronic RASI therapy and in-hospital RASI did not negatively affected patients' survival during the hospitalization, neither increased the risk of SARS-CoV2 infection.

Trial registration number: NCT04412655.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1
Fig. 1
Bar graphs show in-hospital (panel A) and 30-day (panel B) mortality in overall population, in 2019 and 2020 patients according to chronic RASI therapy at admission.
Fig. 2
Fig. 2
Bar graphs show in-hospital (panel A) and 30-day (panel B) mortality in overall population, in 2019 and 2020 patients according to in-hospital RASI therapy.
Fig. 3
Fig. 3
Bar graphs show the prevalence of SARS-CoV2 infection in patients treated in 2020 according to chronic RASI therapy at admission (left side) and in-hospital RASI (right side).
See this image and copyright information in PMC

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