Impact of chronic obstructive pulmonary disease on short-term outcome in patients with ST-elevation myocardial infarction during COVID-19 pandemic: insights from the international multicenter ISACS-STEMI registry
Authors: De Luca Giuseppe , Nardin Matteo , Algowhary Magdy , Uguz Berat , Oliveira Dinaldo C. , Ganyukov Vladimir , Zimbakov Zan , Cercek Miha , Okkels Jensen Lisette , Loh Poay Huan , Calmac Lucian , Roura Ferrer Gerard , Quadros Alexandre , Milewski Marek , Scotto di 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 M. , Lee Michael Kang-yin , Arifa Juzar Dafsah , de Moura Joaquim Rodrigo , Paladino Roberto , Milicic Davor , Davlouros Periklis , Bakraceski Nikola , Zilio Filippo , Donazzan Luca , Kraaijeveld Adriaan , Galasso Gennaro , Lux Arpad , 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 Stephane , Ordoñez Santiago , Özkan Alev Arat , Scheller Bruno , Lehtola Heidi , Teles Rui , Mantis Christos , Antti Ylitalo , Brum Silveira João A. , Zoni Rodrigo , Bessonov Ivan , Savonitto Stefano , Kochiadakis George , Alexopoulos Dimitrios , Uribe Carlos E. , Kanakakis John , Faurie Benjamin , Gabrielli Gabriele , Gutierrez Barrios Alejandro , Bachini Juan Pablo , Rocha Alex , Tam Frankie Chor-Cheung , Rodriguez Alfredo , Lukito Antonia Anna , Saint-Joy Veauthyelau , Pessah Gustavo , Tuccillo Andrea , Cortese Giuliana , Parodi Guido , Bouraghda Mohamed Abed , Kedhi Elvin , Lamelas Pablo , Suryapranata Harry , Verdoia Monica 
Published: August 2022

Background

Chronic obstructive pulmonary disease (COPD) is projected to become the third cause of mortality worldwide. COPD shares several pathophysiological mechanisms with cardiovascular disease, especially atherosclerosis. However, no definite answers are available on the prognostic role of COPD in the setting of ST elevation myocardial infarction (STEMI), especially during COVID-19 pandemic, among patients undergoing primary angioplasty, that is therefore the aim of the current study.

Methods

In the ISACS-STEMI COVID-19 registry we included retrospectively patients with STEMI treated with primary percutaneous coronary intervention (PCI) between March and June of 2019 and 2020 from 109 high-volume primary PCI centers in 4 continents.

Results

A total of 15,686 patients were included in this analysis. Of them, 810 (5.2%) subjects had a COPD diagnosis. They were more often elderly and with a more pronounced cardiovascular risk profile. No preminent procedural dissimilarities were noticed except for a lower proportion of dual antiplatelet therapy at discharge among COPD patients (98.9% vs. 98.1%, P = 0.038). With regards to short-term fatal outcomes, both in-hospital and 30-days mortality occurred more frequently among COPD patients, similarly in pre-COVID-19 and COVID-19 era. However, after adjustment for main baseline differences, COPD did not result as independent predictor for in-hospital death (adjusted OR [95% CI] = 0.913[0.658–1.266], P = 0.585) nor for 30-days mortality (adjusted OR [95% CI] = 0.850 [0.620–1.164], P = 0.310). No significant differences were detected in terms of SARS-CoV-2 positivity between the two groups.

Conclusion

This is one of the largest studies investigating characteristics and outcome of COPD patients with STEMI undergoing primary angioplasty, especially during COVID pandemic. COPD was associated with significantly higher rates of in-hospital and 30-days mortality. However, this association disappeared after adjustment for baseline characteristics. Furthermore, COPD did not significantly affect SARS-CoV-2 positivity.

Trial registration number: NCT 04412655 (2nd June 2020).