Age-Related Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI: Results of the ISACS-STEMI COVID-19 Registry

• Authors: GIUSEPPE De Luca; ALGOWHARY Magdy; UGUZ Berat; OLIVEIRA Dinaldo C; GANYUKOV Vladimir; BUSLJETIK Oliver; CERCEK Miha; JENSEN Lisette Okkels; LOH Poay Huan; CALMAC Lucian; FERRER Gerard Roura i; QUADROS Alexandre; MILEWSKI Marek; UCCIO Fortunato Scotto; CLEMENS von Birgelen; VERSACI Francesco; JURRIEN Ten Berg; CASELLA Gianni; LUNG Aaron Wong Sung; KALA Petr; GIL Jose Luis Diez; CARRILLO Xavier; DIRKSEN Maurits; MUNOZ Victor Becerra; LEE Michael Kang-yin; JUZAR Dafsah Arifa; JOAQUIM Rodrigo de Joaquim; PALADINO Roberto; MILICIC Davor; DAVLOUROS Periklis; BAKRACESKI Nikola; ZILIO Filippo; DONAZZAN Luca; KRAAIJEVELD Adriaan; GALASSO Gennaro; ARPAD Lux; MARINUCCI Lucia; GUIDUCCI Vincenzo; MENICHELLI Maurizio; SCOCCIA Alessandra; YAMAC Aylin Hatice; MERT Kadir Ugur; RIOS Xacobe Flores; KOVARNIK Tomas; KIDAWA Michal; MOREU Jose; FLAVIEN Vincent; FABRIS Enrico; MARTINEZ-LUENGAS Inigo Lozano; BOCCALATTE Marco; OJEDA Francisco Bosa; ARELLANO-SERRANO Carlos; CAIAZZO Gianluca; CIRRINCIONE Giuseppe; KAO Hsien-Li; FORES Juan Sanchis; VIGNALI Luigi; PEREIRA Helder; MANZO-SILBERMAN Stephane; ORDONEZ Santiago; ALEV Arat Ozkan; SCHELLER Bruno; LEHITOLA Heidi; TELES Rui; MANTIS Christos; ANTTI Ylitalo; SILVEIRA Joao Antonio Brum; ZONI Cesar Rodrigo; BESSONOV Ivan; UCCELLO Giuseppe; KOCHIADAKIS George; ALEXOPULOS Dimitrios; URIBE Carlos E; KANAKAKIS John; FAURIE Benjamin; GABRIELLI Gabriele; BARRIOS Alejandro Gutierrez; BACHINI Juan Pablo; ROCHA Alex; TAM Frankie C C; RODRIGUEZ Alfredo; LUKITO Antonia Anna; SAINT-JOY Veauthyelau; PESSAH Gustavo; TUCCILLO Andrea; IELASI Alfonso; CORTESE Giuliana; PARODI Guido; BURGADHA Mohammed Abed; KEDHI Elvin; LAMELAS Pablo; SURYAPRANATA Harry; NARDIN Matteo; VERDOIA Monica
• Year of publication: 2023
• Type: Article in Periodical
• Magazine / Source: Journal of Clinical Medicine
• MU Faculty or unit: Faculty of Medicine
• Web: https://www.mdpi.com/2077-0383/12/6/2116
• Doi: http://dx.doi.org/10.3390/jcm12062116
• Keywords: ageing; ST-segment elevation myocardial infarction; COVID-19
• Description: 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.