Impact of COVID-19 pandemic and diabetes on mechanical reperfusion in patients with STEMI: insights from the ISACS STEMI COVID 19 Registry

Giuseppe De Luca; Miha Cercek; Lisette Okkels Jensen; Marija Vavlukis; Lucian Calmac; Tom Johnson; Gerard Roura I Ferrer; Vladimir Ganyukov; Wojtek Wojakowski; Clemens von Birgelen; Francesco Versaci; Jurrien Ten Berg; Mika Laine; Maurits Dirksen; Gianni Casella; Petr Kala; José Luis Díez Gil; Victor Becerra; Ciro De Simone; Xavier Carrill; Alessandra Scoccia; Arpad Lux; Tomas Kovarnik; Periklis Davlouros; Gabriele Gabrielli; Xacobe Flores Rios; Nikola Bakraceski; Sébastien Levesque; Vincenzo Guiducci; Michał Kidawa; Lucia Marinucci; Filippo Zilio; Gennaro Galasso; Enrico Fabris; Maurizio Menichelli; Stephane Manzo; Gianluca Caiazzo; Jose Moreu; Juan Sanchis Forés; Luca Donazzan; Luigi Vignali; Rui Teles; Francisco Bosa Ojeda; Heidi Lehtola; Santiago Camacho-Freiere; Adriaan Kraaijeveld; Ylitalo Antti; Marco Boccalatte; Iñigo Lozano Martínez-Luengas; Bruno Scheller; Dimitrios Alexopoulos; Giuseppe Uccello; Benjamin Faurie; Alejandro Gutierrez Barrios; Bor Wilbert; Giuliana Cortese; Raul Moreno; Guido Parodi; Elvin Kedhi; Monica Verdoia

doi:10.1186/s12933-020-01196-0

Impact of COVID-19 pandemic and diabetes on mechanical reperfusion in patients with STEMI: insights from the ISACS STEMI COVID 19 Registry

Giuseppe De Luca, Miha Cercek, Lisette Okkels Jensen, Marija Vavlukis, Lucian Calmac, Tom Johnson, Gerard Roura I Ferrer, Vladimir Ganyukov, Wojtek Wojakowski, Clemens von Birgelen, Francesco Versaci, Jurrien Ten Berg, Mika Laine, Maurits Dirksen, Gianni Casella, Petr Kala, José Luis Díez Gil, Victor Becerra, Ciro De Simone, Xavier CarrillAlessandra Scoccia, Arpad Lux, Tomas Kovarnik, Periklis Davlouros, Gabriele Gabrielli, Xacobe Flores Rios, Nikola Bakraceski, Sébastien Levesque, Vincenzo Guiducci, Michał Kidawa, Lucia Marinucci, Filippo Zilio, Gennaro Galasso, Enrico Fabris, Maurizio Menichelli, Stephane Manzo, Gianluca Caiazzo, Jose Moreu, Juan Sanchis Forés, Luca Donazzan, Luigi Vignali, Rui Teles, Francisco Bosa Ojeda, Heidi Lehtola, Santiago Camacho-Freiere, Adriaan Kraaijeveld, Ylitalo Antti, Marco Boccalatte, Iñigo Lozano Martínez-Luengas, Bruno Scheller, Dimitrios Alexopoulos, Giuseppe Uccello, Benjamin Faurie, Alejandro Gutierrez Barrios, Bor Wilbert, Giuliana Cortese, Raul Moreno, Guido Parodi, Elvin Kedhi, Monica Verdoia

Bristol Medical School (THS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

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Abstract

BACKGROUND: It has been suggested the COVID pandemic may have indirectly affected the treatment and outcome of STEMI patients, by avoidance or significant delays in contacting the emergency system. No data have been reported on the impact of diabetes on treatment and outcome of STEMI patients, that was therefore the aim of the current subanalysis conducted in patients included in the International Study on Acute Coronary Syndromes-ST Elevation Myocardial Infarction (ISACS-STEMI) COVID-19.

METHODS: The ISACS-STEMI COVID-19 is a retrospective registry performed in European centers with an annual volume of > 120 primary percutaneous coronary intervention (PCI) and assessed STEMI patients, treated with primary PCI during the same periods of the years 2019 versus 2020 (March and April). Main outcomes are the incidences of primary PCI, delayed treatment, and in-hospital mortality.

RESULTS: A total of 6609 patients underwent primary PCI in 77 centers, located in 18 countries. Diabetes was observed in a total of 1356 patients (20.5%), with similar proportion between 2019 and 2020. During the pandemic, there was a significant reduction in primary PCI as compared to 2019, similar in both patients with (Incidence rate ratio (IRR) 0.79 (95% CI: 0.73-0.85, p < 0.0001) and without diabetes (IRR 0.81 (95% CI: 0.78-0.85, p < 0.0001) (p int = 0.40). We observed a significant heterogeneity among centers in the population with and without diabetes (p < 0.001, respectively). The heterogeneity among centers was not related to the incidence of death due to COVID-19 in both groups of patients. Interaction was observed for Hypertension (p = 0.024) only in absence of diabetes. Furthermore, the pandemic was independently associated with a significant increase in door-to-balloon and total ischemia times only among patients without diabetes, which may have contributed to the higher mortality, during the pandemic, observed in this group of patients.

CONCLUSIONS: The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a similar reduction in primary PCI procedures in both patients with and without diabetes. Hypertension had a significant impact on PCI reduction only among patients without diabetes. We observed a significant increase in ischemia time and door-to-balloon time mainly in absence of diabetes, that contributed to explain the increased mortality observed in this group of patients during the pandemic.

TRIAL REGISTRATION NUMBER: NCT04412655.

Original language	English
Pages (from-to)	215
Journal	Cardiovascular Diabetology
Volume	19
Issue number	1
DOIs	https://doi.org/10.1186/s12933-020-01196-0
Publication status	Published - 18 Dec 2020

Keywords

Aged
COVID-19/diagnosis
Diabetes Mellitus/diagnosis
Europe/epidemiology
Female
Hospital Mortality/trends
Humans
Hypertension/epidemiology
Male
Middle Aged
Percutaneous Coronary Intervention/adverse effects
Registries
Retrospective Studies
Risk Factors
ST Elevation Myocardial Infarction/mortality
Time Factors
Time-to-Treatment/trends
Treatment Outcome

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/s12933-020-01196-0

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De Luca, G., Cercek, M., Jensen, L. O., Vavlukis, M., Calmac, L., Johnson, T., Roura I Ferrer, G., Ganyukov, V., Wojakowski, W., von Birgelen, C., Versaci, F., Ten Berg, J., Laine, M., Dirksen, M., Casella, G., Kala, P., Díez Gil, J. L., Becerra, V., De Simone, C., ... Verdoia, M. (2020). Impact of COVID-19 pandemic and diabetes on mechanical reperfusion in patients with STEMI: insights from the ISACS STEMI COVID 19 Registry. Cardiovascular Diabetology, 19(1), 215. https://doi.org/10.1186/s12933-020-01196-0

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title = "Impact of COVID-19 pandemic and diabetes on mechanical reperfusion in patients with STEMI: insights from the ISACS STEMI COVID 19 Registry",

abstract = "BACKGROUND: It has been suggested the COVID pandemic may have indirectly affected the treatment and outcome of STEMI patients, by avoidance or significant delays in contacting the emergency system. No data have been reported on the impact of diabetes on treatment and outcome of STEMI patients, that was therefore the aim of the current subanalysis conducted in patients included in the International Study on Acute Coronary Syndromes-ST Elevation Myocardial Infarction (ISACS-STEMI) COVID-19.METHODS: The ISACS-STEMI COVID-19 is a retrospective registry performed in European centers with an annual volume of > 120 primary percutaneous coronary intervention (PCI) and assessed STEMI patients, treated with primary PCI during the same periods of the years 2019 versus 2020 (March and April). Main outcomes are the incidences of primary PCI, delayed treatment, and in-hospital mortality.RESULTS: A total of 6609 patients underwent primary PCI in 77 centers, located in 18 countries. Diabetes was observed in a total of 1356 patients (20.5%), with similar proportion between 2019 and 2020. During the pandemic, there was a significant reduction in primary PCI as compared to 2019, similar in both patients with (Incidence rate ratio (IRR) 0.79 (95% CI: 0.73-0.85, p < 0.0001) and without diabetes (IRR 0.81 (95% CI: 0.78-0.85, p < 0.0001) (p int = 0.40). We observed a significant heterogeneity among centers in the population with and without diabetes (p < 0.001, respectively). The heterogeneity among centers was not related to the incidence of death due to COVID-19 in both groups of patients. Interaction was observed for Hypertension (p = 0.024) only in absence of diabetes. Furthermore, the pandemic was independently associated with a significant increase in door-to-balloon and total ischemia times only among patients without diabetes, which may have contributed to the higher mortality, during the pandemic, observed in this group of patients.CONCLUSIONS: The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a similar reduction in primary PCI procedures in both patients with and without diabetes. Hypertension had a significant impact on PCI reduction only among patients without diabetes. We observed a significant increase in ischemia time and door-to-balloon time mainly in absence of diabetes, that contributed to explain the increased mortality observed in this group of patients during the pandemic.TRIAL REGISTRATION NUMBER: NCT04412655.",

keywords = "Aged, COVID-19/diagnosis, Diabetes Mellitus/diagnosis, Europe/epidemiology, Female, Hospital Mortality/trends, Humans, Hypertension/epidemiology, Male, Middle Aged, Percutaneous Coronary Intervention/adverse effects, Registries, Retrospective Studies, Risk Factors, ST Elevation Myocardial Infarction/mortality, Time Factors, Time-to-Treatment/trends, Treatment Outcome",

author = "{De Luca}, Giuseppe and Miha Cercek and Jensen, {Lisette Okkels} and Marija Vavlukis and Lucian Calmac and Tom Johnson and {Roura I Ferrer}, Gerard and Vladimir Ganyukov and Wojtek Wojakowski and {von Birgelen}, Clemens and Francesco Versaci and {Ten Berg}, Jurrien and Mika Laine and Maurits Dirksen and Gianni Casella and Petr Kala and {D{\'i}ez Gil}, {Jos{\'e} Luis} and Victor Becerra and {De Simone}, Ciro and Xavier Carrill and Alessandra Scoccia and Arpad Lux and Tomas Kovarnik and Periklis Davlouros and Gabriele Gabrielli and {Flores Rios}, Xacobe and Nikola Bakraceski and S{\'e}bastien Levesque and Vincenzo Guiducci and Micha{\l} Kidawa and Lucia Marinucci and Filippo Zilio and Gennaro Galasso and Enrico Fabris and Maurizio Menichelli and Stephane Manzo and Gianluca Caiazzo and Jose Moreu and {Sanchis For{\'e}s}, Juan and Luca Donazzan and Luigi Vignali and Rui Teles and {Bosa Ojeda}, Francisco and Heidi Lehtola and Santiago Camacho-Freiere and Adriaan Kraaijeveld and Ylitalo Antti and Marco Boccalatte and Mart{\'i}nez-Luengas, {I{\~n}igo Lozano} and Bruno Scheller and Dimitrios Alexopoulos and Giuseppe Uccello and Benjamin Faurie and {Gutierrez Barrios}, Alejandro and Bor Wilbert and Giuliana Cortese and Raul Moreno and Guido Parodi and Elvin Kedhi and Monica Verdoia",

year = "2020",

month = dec,

day = "18",

doi = "10.1186/s12933-020-01196-0",

language = "English",

volume = "19",

pages = "215",

journal = "Cardiovascular Diabetology",

issn = "1475-2840",

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number = "1",

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De Luca, G, Cercek, M, Jensen, LO, Vavlukis, M, Calmac, L, Johnson, T, Roura I Ferrer, G, Ganyukov, V, Wojakowski, W, von Birgelen, C, Versaci, F, Ten Berg, J, Laine, M, Dirksen, M, Casella, G, Kala, P, Díez Gil, JL, Becerra, V, De Simone, C, Carrill, X, Scoccia, A, Lux, A, Kovarnik, T, Davlouros, P, Gabrielli, G, Flores Rios, X, Bakraceski, N, Levesque, S, Guiducci, V, Kidawa, M, Marinucci, L, Zilio, F, Galasso, G, Fabris, E, Menichelli, M, Manzo, S, Caiazzo, G, Moreu, J, Sanchis Forés, J, Donazzan, L, Vignali, L, Teles, R, Bosa Ojeda, F, Lehtola, H, Camacho-Freiere, S, Kraaijeveld, A, Antti, Y, Boccalatte, M, Martínez-Luengas, IL, Scheller, B, Alexopoulos, D, Uccello, G, Faurie, B, Gutierrez Barrios, A, Wilbert, B, Cortese, G, Moreno, R, Parodi, G, Kedhi, E & Verdoia, M 2020, 'Impact of COVID-19 pandemic and diabetes on mechanical reperfusion in patients with STEMI: insights from the ISACS STEMI COVID 19 Registry', Cardiovascular Diabetology, vol. 19, no. 1, pp. 215. https://doi.org/10.1186/s12933-020-01196-0

TY - JOUR

T1 - Impact of COVID-19 pandemic and diabetes on mechanical reperfusion in patients with STEMI

T2 - insights from the ISACS STEMI COVID 19 Registry

AU - De Luca, Giuseppe

AU - Cercek, Miha

AU - Jensen, Lisette Okkels

AU - Vavlukis, Marija

AU - Calmac, Lucian

AU - Johnson, Tom

AU - Roura I Ferrer, Gerard

AU - Ganyukov, Vladimir

AU - Wojakowski, Wojtek

AU - von Birgelen, Clemens

AU - Versaci, Francesco

AU - Ten Berg, Jurrien

AU - Laine, Mika

AU - Dirksen, Maurits

AU - Casella, Gianni

AU - Kala, Petr

AU - Díez Gil, José Luis

AU - Becerra, Victor

AU - De Simone, Ciro

AU - Carrill, Xavier

AU - Scoccia, Alessandra

AU - Lux, Arpad

AU - Kovarnik, Tomas

AU - Davlouros, Periklis

AU - Gabrielli, Gabriele

AU - Flores Rios, Xacobe

AU - Bakraceski, Nikola

AU - Levesque, Sébastien

AU - Guiducci, Vincenzo

AU - Kidawa, Michał

AU - Marinucci, Lucia

AU - Zilio, Filippo

AU - Galasso, Gennaro

AU - Fabris, Enrico

AU - Menichelli, Maurizio

AU - Manzo, Stephane

AU - Caiazzo, Gianluca

AU - Moreu, Jose

AU - Sanchis Forés, Juan

AU - Donazzan, Luca

AU - Vignali, Luigi

AU - Teles, Rui

AU - Bosa Ojeda, Francisco

AU - Lehtola, Heidi

AU - Camacho-Freiere, Santiago

AU - Kraaijeveld, Adriaan

AU - Antti, Ylitalo

AU - Boccalatte, Marco

AU - Martínez-Luengas, Iñigo Lozano

AU - Scheller, Bruno

AU - Alexopoulos, Dimitrios

AU - Uccello, Giuseppe

AU - Faurie, Benjamin

AU - Gutierrez Barrios, Alejandro

AU - Wilbert, Bor

AU - Cortese, Giuliana

AU - Moreno, Raul

AU - Parodi, Guido

AU - Kedhi, Elvin

AU - Verdoia, Monica

PY - 2020/12/18

Y1 - 2020/12/18

N2 - BACKGROUND: It has been suggested the COVID pandemic may have indirectly affected the treatment and outcome of STEMI patients, by avoidance or significant delays in contacting the emergency system. No data have been reported on the impact of diabetes on treatment and outcome of STEMI patients, that was therefore the aim of the current subanalysis conducted in patients included in the International Study on Acute Coronary Syndromes-ST Elevation Myocardial Infarction (ISACS-STEMI) COVID-19.METHODS: The ISACS-STEMI COVID-19 is a retrospective registry performed in European centers with an annual volume of > 120 primary percutaneous coronary intervention (PCI) and assessed STEMI patients, treated with primary PCI during the same periods of the years 2019 versus 2020 (March and April). Main outcomes are the incidences of primary PCI, delayed treatment, and in-hospital mortality.RESULTS: A total of 6609 patients underwent primary PCI in 77 centers, located in 18 countries. Diabetes was observed in a total of 1356 patients (20.5%), with similar proportion between 2019 and 2020. During the pandemic, there was a significant reduction in primary PCI as compared to 2019, similar in both patients with (Incidence rate ratio (IRR) 0.79 (95% CI: 0.73-0.85, p < 0.0001) and without diabetes (IRR 0.81 (95% CI: 0.78-0.85, p < 0.0001) (p int = 0.40). We observed a significant heterogeneity among centers in the population with and without diabetes (p < 0.001, respectively). The heterogeneity among centers was not related to the incidence of death due to COVID-19 in both groups of patients. Interaction was observed for Hypertension (p = 0.024) only in absence of diabetes. Furthermore, the pandemic was independently associated with a significant increase in door-to-balloon and total ischemia times only among patients without diabetes, which may have contributed to the higher mortality, during the pandemic, observed in this group of patients.CONCLUSIONS: The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a similar reduction in primary PCI procedures in both patients with and without diabetes. Hypertension had a significant impact on PCI reduction only among patients without diabetes. We observed a significant increase in ischemia time and door-to-balloon time mainly in absence of diabetes, that contributed to explain the increased mortality observed in this group of patients during the pandemic.TRIAL REGISTRATION NUMBER: NCT04412655.

AB - BACKGROUND: It has been suggested the COVID pandemic may have indirectly affected the treatment and outcome of STEMI patients, by avoidance or significant delays in contacting the emergency system. No data have been reported on the impact of diabetes on treatment and outcome of STEMI patients, that was therefore the aim of the current subanalysis conducted in patients included in the International Study on Acute Coronary Syndromes-ST Elevation Myocardial Infarction (ISACS-STEMI) COVID-19.METHODS: The ISACS-STEMI COVID-19 is a retrospective registry performed in European centers with an annual volume of > 120 primary percutaneous coronary intervention (PCI) and assessed STEMI patients, treated with primary PCI during the same periods of the years 2019 versus 2020 (March and April). Main outcomes are the incidences of primary PCI, delayed treatment, and in-hospital mortality.RESULTS: A total of 6609 patients underwent primary PCI in 77 centers, located in 18 countries. Diabetes was observed in a total of 1356 patients (20.5%), with similar proportion between 2019 and 2020. During the pandemic, there was a significant reduction in primary PCI as compared to 2019, similar in both patients with (Incidence rate ratio (IRR) 0.79 (95% CI: 0.73-0.85, p < 0.0001) and without diabetes (IRR 0.81 (95% CI: 0.78-0.85, p < 0.0001) (p int = 0.40). We observed a significant heterogeneity among centers in the population with and without diabetes (p < 0.001, respectively). The heterogeneity among centers was not related to the incidence of death due to COVID-19 in both groups of patients. Interaction was observed for Hypertension (p = 0.024) only in absence of diabetes. Furthermore, the pandemic was independently associated with a significant increase in door-to-balloon and total ischemia times only among patients without diabetes, which may have contributed to the higher mortality, during the pandemic, observed in this group of patients.CONCLUSIONS: The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a similar reduction in primary PCI procedures in both patients with and without diabetes. Hypertension had a significant impact on PCI reduction only among patients without diabetes. We observed a significant increase in ischemia time and door-to-balloon time mainly in absence of diabetes, that contributed to explain the increased mortality observed in this group of patients during the pandemic.TRIAL REGISTRATION NUMBER: NCT04412655.

KW - Aged

KW - COVID-19/diagnosis

KW - Diabetes Mellitus/diagnosis

KW - Europe/epidemiology

KW - Female

KW - Hospital Mortality/trends

KW - Humans

KW - Hypertension/epidemiology

KW - Male

KW - Middle Aged

KW - Percutaneous Coronary Intervention/adverse effects

KW - Registries

KW - Retrospective Studies

KW - Risk Factors

KW - ST Elevation Myocardial Infarction/mortality

KW - Time Factors

KW - Time-to-Treatment/trends

KW - Treatment Outcome

U2 - 10.1186/s12933-020-01196-0

DO - 10.1186/s12933-020-01196-0

M3 - Article (Academic Journal)

C2 - 33339541

SN - 1475-2840

VL - 19

SP - 215

JO - Cardiovascular Diabetology

JF - Cardiovascular Diabetology

IS - 1

ER -

Impact of COVID-19 pandemic and diabetes on mechanical reperfusion in patients with STEMI: insights from the ISACS STEMI COVID 19 Registry

Abstract

Keywords

UN SDGs

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