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Coronary artery disease
Original research
COVID-19 pandemic, mechanical reperfusion and 30-day mortality in ST elevation myocardial infarction
  1. Giuseppe De Luca1,2,
  2. Magdy Algowhary3,
  3. Berat Uguz4,
  4. Dinaldo C Oliveira5,
  5. Vladimir Ganyukov6,
  6. Zan Zimbakov7,
  7. Miha Cercek8,
  8. Lisette Okkels Jensen9,
  9. Poay Huan Loh10,
  10. Lucian Calmac11,
  11. Gerard Roura-Ferrer12,
  12. Alexandre Quadros13,
  13. Marek Milewski14,
  14. Fortunato Scotto di Uccio15,
  15. Clemens von Birgelen16,
  16. Francesco Versaci17,
  17. Jurriën Ten Berg18,
  18. Gianni Casella19,
  19. Aaron Sung Lung Wong20,
  20. Petr Kala21,
  21. Jose Luis Diez Gil22,
  22. Xavier Carrillo23,
  23. Maurits Theodoor Dirksen24,
  24. Víctor Manuel Becerra-Muñoz25,
  25. Michael Kang-yin Lee26,
  26. Dafsah A Juzar27,
  27. Rodrigo de Moura Joaquim28,
  28. Roberto Paladino29,
  29. Davor Milicic30,
  30. Periklis Davlouros31,
  31. Nikola Bakraceski32,
  32. Filippo Zilio33,
  33. Luca Donazzan34,
  34. Adriaan O Kraaijeveld35,
  35. Gennaro Galasso36,
  36. Arpad Lux37,
  37. Lucia Marinucci38,
  38. Vincenzo Guiducci39,
  39. Maurizio Menichelli40,41,
  40. Alessandra Scoccia42,
  41. Aylin Yamac43,
  42. Kadir Ugur Mert44,
  43. Xacobe Flores Rios45,
  44. Tomas Kovarnik46,
  45. Michal Kidawa47,
  46. Jose Moreu48,
  47. Vincent Flavien49,
  48. Enrico Fabris50,
  49. Iñigo Lozano Martìnez-Luengas51,
  50. Marco Boccalatte52,
  51. Francisco Bosa Ojeda53,
  52. Carlos Arellano-Serrano54,
  53. Gianluca Caiazzo55,
  54. Giuseppe Cirrincione56,
  55. Hsien-Li Kao57,
  56. Juan Sanchis Fores58,
  57. Luigi Vignali59,
  58. Helder Pereira60,
  59. Stéphane Manzo-Silberman61,
  60. Santiago Ordonez62,
  61. Alev Arat Özkan63,
  62. Bruno Scheller64,
  63. Heidi Lehtola65,
  64. Rui Teles66,
  65. Christos Mantis67,
  66. Antti Ylitalo68,
  67. Joao Antonio Brum Silveira69,
  68. Rodrigo Zoni70,
  69. Ivan Bessonov71,
  70. Stefano Savonitto72,
  71. George Kochiadakis73,
  72. Dimitrios Alexopoulos74,
  73. Carlos Uribe75,
  74. John Kanakakis76,
  75. Benjamin Faurie77,
  76. Gabriele Gabrielli78,
  77. Alejandro Gutiérrez79,
  78. Juan Pablo Bachini80,
  79. Alex Rocha81,
  80. Franckie CC Tam82,
  81. Alfredo Rodriguez83,
  82. Antonia Lukito84,
  83. Veauthyelau Saint-Joy85,
  84. Gustavo Pessah86,
  85. Bernardino Tuccillo15,
  86. Giuliana Cortese87,
  87. Guido Parodi88,
  88. Mohamed Abed Bouraghda89,
  89. Elvin Kedhi90,
  90. Pablo Lamelas62,
  91. Harry Suryapranata91,
  92. Matteo Nardin2,92,
  93. Monica Verdoia2,93
  94. ISACS-STEMI COVID-19
    1. 1Department of Cardiology, AOU Maggiore della Carità, Eastern Piedmont University, Novara, Italy
    2. 2Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
    3. 3Division of Cardiology, Assiut University, Assiut, Egypt
    4. 4Division of Cardiology, Bursa City Hospital, Bursa, Turkey
    5. 5Pronto de Socorro Cardiologico, Centro PROCAPE Prof. Tavares, Recife, Brazil
    6. 6Department of Heart and Vascular Surgery, Kemerovo Cardiology Center, Кемерово, Russia
    7. 7University Clinic for Cardiology, Ss Cyril and Methodius University in Skopje, Skopje, Macedonia
    8. 8Centre for Intensive Internal Medicine, University Medical Centre, Ljubljana, Slovenia
    9. 9Division of Cardiology, Odense Universitetshospital, Odense, Denmark
    10. 10Department of Cardiology, Singapore Health Service, Singapore
    11. 11Clinic Emergency Hospital, University of Bucharest, Bucuresti, Romania
    12. 12Interventional Cardiology Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
    13. 13Instituto de Cardiologia, Rio Grande do Sul State Department of Health, Porto Alegre, Brazil
    14. 14Division of Cardiology, Medical University of Silesia in Katowice, Katowice, Poland
    15. 15Division of Cardiology, Ospedale del Mare, Napoli, Italy
    16. 16Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Academisch Medisch Centrum, Twente, The Netherlands
    17. 17Department of Cardiology, S Maria Goretti Hospital, Latina, Italy
    18. 18Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands
    19. 19Cardiology, Ospedale Maggiore Bologna, Bologna, Italy
    20. 20Cardiology, National Heart Centre Singapore, Singapore
    21. 21University Hospital Brno, Masaryk University, Brno, Czech Republic
    22. 22Department of Cardiology, Hospital Universitari i Politecnic La Fe, Valencia, Spain
    23. 23Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
    24. 24Cardiology, Medical Centre Alkmaar, Alkmaar, The Netherlands
    25. 25Department of Cardiology, University Hospital Virgen de la Victoria, Malaga, Spain
    26. 26Department of Cardiology, Queen ElizabethHospital University of Hong Kong, Hong Kong, Hong Kong
    27. 27Department of cardiology and Vascular Medicine, National Cardiovascular Center 'Harapan Kita', Jakarta, Indonesia
    28. 28Instituto de Cardiologia, Santa Catarina Praia Comprida, Sao Jose, Brazil
    29. 29Division of Cardiology, Villa dei fiori Srl, Acerra, Italy
    30. 30Department of Cardiology, University of Zagreb, Zagreb, Croatia
    31. 31Department of Cardiology, University of Patras, Patras, Greece
    32. 32Center for Cardiovascular Diseases, Ohrid University Hospital, Ohrid, Macedonia
    33. 33Division of Cardiology, Ospedale Santa Chiara di Trento, Trento, Italy
    34. 34Cardiology, Ospedale di Bolzano, Bolzano, Italy
    35. 35Division of Cardiology, Utrecht University, Utrecht, The Netherlands
    36. 36Division of Cardiology, University of Salerno, Salerno, Italy
    37. 37Cardiology, Maastricht University Hospital, Maastricht, The Netherlands
    38. 38Division of Cardiology, Azienda Ospedaliera “Ospedali Riuniti Marche Nord”, Ancona, Italy
    39. 39Division of Cardiology, ASL 3 Reggio Emilia, Reggio Emilia, Italy
    40. 40Cardiology Division, Ospedale Fabrizio Spaziani, Roma, Italy
    41. 41Cardiology Division, Ospedale “F. Spaziani“, Frosinone, Italy
    42. 42Division of Cardiology, Ospedale S. Anna Ferrara, Ferrara, Italy
    43. 43Department of Cardiology, Bezmialem Vakıf University İstanbul, Istanbul, Turkey
    44. 44Division of Cardiology, Eskisehir Osmangazi Universitesi, Eskisehir, Turkey
    45. 45Complexo Hospetaliero Universitario, La Coruna, La Coruna, Spain
    46. 46Department of Cardiovascular Medicine, University Hospital Prague, Prague, Czech Republic
    47. 47Central Hospital, Medical University of Lodz, Lodz, Poland
    48. 48Division of Cardiology, Hospital Complex of Toledo, Toledo, Spain
    49. 49Division of Cardiology, Lille University Hospital Center, Lille, France
    50. 50Department of Cardiology, Universita degli Studi di Trieste Dipartimento di Scienze Mediche Chirurgiche e della Salute, Trieste, Italy
    51. 51Division of Cardiology, Hospital de Cabueñes, Gijon, Spain
    52. 52Division of Cardiology, Ospedale Santa Maria delle Grazie, Pozzuoli, Naples, Italy
    53. 53Division of Cardiology, Consorcio Sanitario de Tenerife, Santa Cruz de Tenerife, Spain
    54. 54Division of Cardiology, Hospital Puerta de Hierro Mahadahonda, Barcelona, Spain
    55. 55Division of Cardiology, Ospedale “G Moscati”, Aversa, Aversa, Italy
    56. 56Division of Cardiology, Ospedale Civico Arnas, Palermo, Italy
    57. 57Cardiology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
    58. 58Department of Cardiology, Hospital Clinico Universitario, Universidad de Valencia, Valencia, Spain
    59. 59Interventional Cardiology Unit, Azienda Ospedaliera Sanitaria, Parma, Parma, Italy
    60. 60Cardiology Department, Garcia de Orta Hospital, Almada, Portugal
    61. 61Department of Cardiology, INSERM Délégation Régionale Paris 7, Bagnolet, France
    62. 62Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
    63. 63Cardiology Institute, Istanbul University, Istanbul, Turkey
    64. 64Clinical and Experimental Interventional Cardiology, Saarland University, Saarbrucken, Germany
    65. 65Division of Cardiology, Oulu University Hospital, Oulu, Finland
    66. 66Department of Cardiology, Hospital de Santa Cruz, CHLO - Nova Medical School,CEDOC, Carnaxide, Portugal
    67. 67Division of Cardiology, Kontantopoulion Hospital, Athens, Athens, Greece
    68. 68Division of Cardiology, Heart Centre Turku, Turku, Finland
    69. 69Division of Cardiology, Hospital de Santo António, Porto, Portugal
    70. 70Instituto de Cardiología de Corrientes Juana Francisca Cabral, Corrientes, Argentina
    71. 71Cardiology, Tyumen Research Centre, Tyumen, Russia
    72. 72Cardiology, Ospedale Alessandro Manzoni, Lecco, Italy
    73. 73Division of Cardiology, Iraklion University Hospital, Heraklion, Greece
    74. 74Division of Cardiology, Attikon Clinic, Athens, Greece
    75. 75Division of Cardiology, Medellin Clinic Universidad UPB, Medellin, Colombia
    76. 76Division of Cardiology, General Hospital of Athens Alexandra, Athens, Greece
    77. 77Division of Cardiology, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
    78. 78SOD Cardiologia-Emodinamica-UTIC, Azienda Ospedali Riuniti - Presidio 'GM Lancisi', Ancona, Italy
    79. 79Hospital Universitario Puerta del Mar Servicio de Cardiología, Cadiz, Spain
    80. 80Instituto de Cardiologia Integral, Montevideo, Uruguay
    81. 81Department of Cardiology and Cardiovascular Interventions, Instituto Nacional de Cirugía Cardíaca, Montevideo, Uruguay
    82. 82Department of Cardiology, Queen Mary Hospital, Hong Kong, Hong Kong
    83. 83Department of Cardiology, Otamendi Hospital, Buenos Aires, Argentina
    84. 84Cardiovascular Department, Pelita Harapan University, Tangerang, Indonesia
    85. 85Centre Hospitalier d Antibes Juan les Pins, Antibes, France
    86. 86Division of Cardiology, Cordoba Hospital, Cordoba, Argentina
    87. 87Department of Statistical Sciences, University of Padova, Padova, Italy
    88. 88Division of cardiology, Sassari University Hospital, Sassari, Italy
    89. 89Division of cardiology, Blida University Hospital, Blida, Algeria
    90. 90Cardiology, Hopital Erasmus, Universitè Libre de Bruxelles, Bruxelles, Belgium
    91. 91Cardiology, Radboud UMC, Nijmegen, The Netherlands
    92. 92Ospedali Riuniti, Brescia, Italy
    93. 93Cardiology, Nuovo Ospedale degli Infermi ASL Biella, Biella, italy
    1. Correspondence to Prof Giuseppe De Luca, Cardiology, 1. AOU Maggiore della Carità, Eastern Piedmont University, 13100 Vercelli VC, Novara, Italy, Novara, Italy; giuseppe.deluca{at}med.uniupo.it

    Abstract

    Objective The 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).

    Methods This 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.

    Results In 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.

    Conclusion Percutaneous 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 number NCT04412655.

    • COVID-19
    • myocardial infarction
    • percutaneous coronary intervention

    Data availability statement

    Data are available upon reasonable request. Data will be available upon reasonable request starting for 6 months after publication.

    This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

    https://bmj.com/coronavirus/usage

    https://doi.org/10.1136/heartjnl-2021-319750

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      Data availability statement

      Data are available upon reasonable request. Data will be available upon reasonable request starting for 6 months after publication.

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      Footnotes

      • Twitter @no, @Xavi_Carrillo7, @inigo.lozano@gmail.com, @lamelaspablo

      • Collaborators ISACS-STEMI COVID 19: Tom Johnson, Tim Kinnaird, Yves Cottin, Alexander IJsselmuiden, Kees-Jan Royaards, Massimo Siviglia, Giovanni Amoroso, Adrian Banning, Andrea Santucci, Leonardo Spedicato, Julinda Mehilli, Sébastien Levesque, Peter Ludman, Pierre Deharo, Edouard Benit, Pierfrancesco Agostoni, Santiago Camacho-Freiere; Marc Brouwer, Cyril Camaro, Bor Wilbert; Pieter Smits, Mike Laine, Raul Moreno.

      • Contributors Study design: GDL, GPa, EK and MV. Data collection: all authors. Data verification: MN, MV. Data analysis: GC. Initial draft: GDL. Final revision and approval of the manuscript: all authors.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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