COVID-19 pandemic, mechanical reperfusion and 30-day mortality in ST elevation myocardial infarction
Authors: De Luca Giuseppe , Algowhary Magdy , Uguz Berat , Oliveira Dinaldo C , Ganyukov Vladimir , Zimbakov Zan , Cercek Miha , Jensen Lisette Okkels , Loh Poay Huan , Calmac Lucian , Roura-Ferrer Gerard , Quadros Alexandre , Milewski Marek , Scotto di Uccio Fortunato , von Birgelen Clemens , Versaci Francesco , Ten Berg Jurriën , Casella Gianni , Wong Aaron Sung Lung , Kala Petr , Diez Gil Jose Luis , Carrillo Xavier , Dirksen Maurits Theodoor , Becerra-Muñoz Víctor Manuel , Kang-yin Lee Michael , Juzar Dafsah A , de Moura Joaquim Rodrigo , Paladino Roberto , Milicic Davor , Davlouros Periklis , Bakraceski Nikola , Zilio Filippo , Donazzan Luca , Kraaijeveld Adriaan O , Galasso Gennaro , Lux Arpad , Marinucci Lucia , Guiducci Vincenzo , Menichelli Maurizio , Scoccia Alessandra , Yamac Aylin , Ugur Mert Kadir , Flores Rios Xacobe , Kovarnik Tomas , Kidawa Michal , Moreu Jose , Flavien Vincent , Fabris Enrico , Lozano Martìnez-Luengas Iñigo , Boccalatte Marco , Bosa Ojeda Francisco , Arellano-Serrano Carlos , Caiazzo Gianluca , Cirrincione Giuseppe , Kao Hsien-Li , Sanchis Fores Juan , Vignali Luigi , Pereira Helder , Manzo-Silberman Stéphane , Ordonez Santiago , Özkan Alev Arat , Scheller Bruno , Lehtola Heidi , Teles Rui , Mantis Christos , Ylitalo Antti , Brum Silveira Joao Antonio , Zoni Rodrigo , Bessonov Ivan , Savonitto Stefano , Kochiadakis George , Alexopoulos Dimitrios , Uribe Carlos , Kanakakis John , Faurie Benjamin , Gabrielli Gabriele , Gutiérrez Alejandro , Bachini Juan Pablo , Rocha Alex , Tam Franckie CC , Rodriguez Alfredo , Lukito Antonia , Saint-Joy Veauthyelau , Pessah Gustavo , Tuccillo Bernardino , Cortese Giuliana , Parodi Guido , Bouraghda Mohamed Abed , Kedhi Elvin , Lamelas Pablo , Suryapranata Harry , Nardin Matteo , Verdoia Monica 
Published: October 2021

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.