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: De Luca Giuseppe , 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 
Published: March 2023

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.