Age-Related Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI

• Main Author: De Luca, Giuseppe
• Publication Date: 2023
• Other Authors: 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, Scotto D’Uccio, Fortunato, von Birgelen, Clemens, Versaci, Francesco, Ten Berg, Jurrien, Casella, Gianni, Wong Sung Lung, Aaron, Kala, Petr, Díez Gil, José Luis, Carrillo, Xavier, Dirksen, Maurits, Becerra Munoz, Victor, Lee, Michael Kang yin, Juzar, Dafsah Arifa, de Moura Joaquim, Rodrigo, 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, Ugur Mert, Kadir, Flores Rios, Xacobe, Kovarnik, Tomas, Kidawa, Michal, Moreu, Josè, Flavien, Vincent, Fabris, Enrico, Martínez-Luengas, Iñigo Lozano, Boccalatte, Marco, Bosa Ojeda, Francisco, Arellano-Serrano, Carlos, Caiazzo, Gianluca, Cirrincione, Giuseppe, Kao, Hsien Li, Sanchis Forés, Juan, Vignali, Luigi, Pereira, Helder, Manzo-Silberman, Stephane, Ordoñez, Santiago, Arat Özkan, Alev, Scheller, Bruno, Lehitola, Heidi, Teles, Rui, Mantis, Christos, Antti, Ylitalo, Brum Silveira, João António, Zoni, Cesar Rodrigo, Bessonov, Ivan, Uccello, Giuseppe, Kochiadakis, George, Alexopulos, Dimitrios, Uribe, Carlos E., Kanakakis, John, Faurie, Benjamin, Gabrielli, Gabriele, Gutierrez Barrios, Alejandro, 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
• Format: Article
• Language: eng
• Source: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Download full: http://hdl.handle.net/10362/153052
• topic: ageing; COVID-19; ST-segment elevation myocardial infarction; Medicine(all)

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.