Age-Related Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI: Results of the ISACS-STEMI COVID-19 Registry
Abstract
:1. Background
2. Study Design and Population
3. Results
4. Baseline Demographic and Clinical Characteristics
5. Procedural Characteristics
6. In-Hospital and 30-Day Mortality
7. Discussion
8. Limitations
9. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
PCI | Percutaneous coronary intervention |
STEMI | ST-segment elevation myocardial infarction |
DTB | Door-to-balloon time |
IRR | Incidence rate ratio |
ACS | Acute coronary syndrome |
DES | Drug-eluting stent |
RASI | Renin-angiotensin system inhibitors |
References
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Elderly 2019 (n = 1682) | Elderly 2020 (n = 1365) | p Value | Young 2019 (n = 7016) | Young 2020 (n = 6020) | p Value | |
---|---|---|---|---|---|---|
Age (median, IQR) | 81 (77–85) | 81 (77–85) | 0.97 | 60 (52–66) | 59 (52–66) | 0.33 * |
Male gender—n (%) | 967 (57.5) | 805 (59.0) | 0.409 | 5604 (79.9) | 4788 (79.5) | 0.631 |
Medical History | ||||||
Hypertension—n (%) | 1212 (72.1) | 987 (72.3) | 0.878 | 3533 (50.4) | 3081 (51.2) | 0.349 |
Diabetes mellitus—n (%) | 490 (29.1) | 390 (28.6) | 0.734 | 1548 (22.1) | 1384 (23.0) | 0.207 |
Hypercholesterolemia—n (%) | 721 (42.9) | 611 (44.8) | 0.294 | 2724 (38.8) | 2297 (38.2) | 0.434 |
Active smoker—n (%) | 515 (30.6) | 408 (29.9) | 0.664 | 4314 (61.5) | 3549 (59.0) | 0.003 |
Family history of CAD—n (%) | 200 (11.9) | 128 (9.4) | 0.026 | 1635 (23.3) | 1335 (22.2) | 0.126 |
Previous STEMI—n (%) | 195 (11.6) | 153 (11.2) | 0.740 | 637 (9.1) | 558 (9.3) | 0.708 |
Previous PCI—n (%) | 245 (14.6) | 211 (15.5) | 0.493 | 793 (11.3) | 744 (12.4) | 0.062 |
Previous CABG—n (%) | 63 (3.7) | 50 (3.7) | 0.905 | 81 (1.2) | 78 (1.3) | 0.464 |
Geographic area | 0.038 | <0.001 | ||||
Europe—n (%) | 1476 (87.8) | 1176 (86.2) | 5507 (78.5) | 4655 (77.3) | ||
Latin America—n (%) | 89 (5.3) | 106 (7.8) | 541 (7.7) | 614 (10.2) | ||
Southeast Asia—n (%) | 92 (5.5) | 67 (4.9) | 614 (8.8) | 520 (8.6) | ||
North Africa—n (%) | 25 (1.5) | 16 (1.2) | 354 (5.0) | 231 (3.8) | ||
Referral to Primary PCI Hospital | ||||||
Type | 0.212 | 0.755 | ||||
Ambulance (from community)—n (%) | 848 (50.4) | 720 (52.7) | 3314 (47.2) | 2856 (47.4) | ||
Direct access to hub—n (%) | 439 (26.1) | 319 (23.4) | 2010 (28.6) | 1745 (29.0) | ||
Transfer from spoke—n (%) | 395 (23.5) | 326 (23.9) | 1692 (24.1) | 1419 (23.6) | ||
Time delays | ||||||
Ischemia time, median (25–75th) | 225 (140–375) | 244 (150–430) | <0.0001 | 190 (120–345) | 220 (130–402) | <0.0001 * |
Total ischemia time | 0.009 | <0.001 | ||||
<6 h—n (%) | 1257 (74.7) | 945 (69.2) | 5365 (76.5) | 4355 (72.3) | ||
6–12 h—n (%) | 249 (14.8) | 243 (17.8) | 1035 (14.8) | 972 (16.1) | ||
12–24 h—n (%) | 113 (6.7) | 110 (8.1) | 424 (6.0) | 441 (7.3) | ||
>24 h—n (%) | 63 (3.7) | 67 (4.9) | 192 (2.7) | 252 (4.2) | ||
Total ischemia time > 12 h—n (%) | 176 (10.5) | 177 (13.0) | 0.032 | 616 (8.8) | 693 (11.5) | <0.001 * |
Door-to-balloon time, median (25–75th) | 40 (25–70) | 40 (26–74) | 0.071 | 40 (25–62) | 40 (25–70) | 0.001 * |
Door-to-balloon time | 0.428 | 0.001 | ||||
<30 min—n (%) | 675 (40.1) | 517 (37.9) | 2904 (41.4) | 2337 (38.8) | ||
30–60 min—n (%) | 527 (31.3) | 438 (32.1) | 2318 (33.0) | 1976 (32.8) | ||
>60 min—n (%) | 480 (28.5) | 410 (30.0) | 1794 (25.6) | 1707 (28.4) | ||
Door-to-balloon time > 30 min—n (%) | 1007 (59.9) | 848 (62.1) | 0.205 | 4112 (58.6) | 3683 (61.2) | 0.003 |
Clinical Presentation | ||||||
Anterior STEMI—n (%) | 803 (47.7) | 654 (47.9) | 0.925 | 3183 (45.4) | 2806 (46.6) | 0.155 |
Out-of-hospital cardiac arrest—n (%) | 87 (5.2) | 63 (4.6) | 0.480 | 428 (6.1) | 378 (6.3) | 0.510 |
Cardiogenic shock—n (%) | 170 (10.1) | 148 (10.8) | 0.509 | 455 (6.5) | 395 (6.6) | 0.550 |
Rescue PCI for failed thrombolysis—n (%) | 82 (4.9) | 57 (4.2) | 0.358 | 523 (7.5) | 437 (7.3) | 0.670 |
Elderly 2019 (n = 1682) | Elderly 2020 (n = 1365) | p Value | Young 2019 (n = 7016) | Young 2020 (n = 6020) | p Value | |
---|---|---|---|---|---|---|
Radial Access (%) | 1221 (72.6) | 1031 (75.5) | 0.066 | 5302 (75.6) | 4714 (78.3) | <0.001 |
Culprit vessel | 0.707 | 0.521 | ||||
Left main—n (%) | 38 (2.3) | 24 (1.8) | 103 (1.5) | 87 (1.4) | ||
Left anterior descending artery—n (%) | 805 (47.9) | 629 (46.1) | 3182 (45.4) | 2742 (45.5) | ||
Circumflex—n (%) | 206 (12.2) | 183 (13.4) | 1040 (14.8) | 921 (15.3) | ||
Right coronary artery—n (%) | 612 (36.4) | 511 (37.4) | 2648 (37.7) | 2230 (37.0) | ||
Anterolateral branch—n (%) | 4 (0.2) | 2 (0.1) | 21 (0.3) | 14 (0.2) | ||
SVG—n (%) | 17 (1.0) | 16 (1.2) | 20 (0.3) | 26 (0.4) | ||
Proximal lesion location—n (%) | ||||||
In-stent thrombosis—n (%) | 67 (4.0) | 69 (5.1) | 0.154 | 272 (3.9) | 224 (3.7) | 0.643 |
Multivesseldisease—n (%) | 928 (55.2) | 775 (56.8) | 0.463 | 3308 (47.1) | 2875 (47.8) | 0.224 |
Preprocedural TIMI 0 flow—n (%) | 1028 (61.1) | 869 (63.7) | 0.149 | 4738 (67.5) | 4096 (68.0) | 0.536 |
Thrombectomy—n (%) | 242 (14.4) | 180 (13.2) | 0.34 | 1160 (16.5) | 981 (16.3) | 0.715 |
Stenting—n (%) | 1491 (88.6) | 1203 (88.1) | 0.66 | 6507 (92.7) | 5565 (92.4) | 0.459 |
Drug-elutingstent—n (%) | 1448 (86.1) | 1176 (86.2) | 0.958 | 6208 (88.5) | 5422 (90.1) | 0.004 |
Postprocedural TIMI 3 flow—n (%) | 1500 (89.2) | 1204 (88.2) | 0.397 | 6530 (93.1) | 5587 (92.8) | 0.555 |
Gp IIb-IIIa inhibitors/cangrelor—n (%) | 248 (14.7) | 229 (16.8) | 0.125 | 1505 (21.5) | 1285 (21.3) | 0.884 |
Bivalirudin—n (%) | 4 (0.2) | 3 (0.2) | 0.918 | 30 (0.4) | 15 (0.2) | 0.083 |
Mechanical support—n (%) | 57 (3.4) | 54 (4.0) | 0.406 | 189 (2.7) | 197 (3.3) | 0.052 |
Additional PCI | 0.444 | 0.001 | ||||
During the index procedure—n (%) | 167 (9.9) | 152 (11.1) | 620 (8.8) | 637 (10.6) | ||
Staged—n (%) | 171 (10.2) | 147 (10.8) | 715 (10.2) | 653 (10.8) | ||
DAPT therapy—n (%) | 1647 (97.9) | 1347 (98.7) | 0.11 | 6946 (99.0) | 5965 (99.1) | 0.623 |
In-hospital RASI—n (%) | 839 (49.9) | 752 (55.1) | 0.004 | 3787 (54.0) | 3519 (58.5) | <0.001 |
In-hospital death—n (%) | 180 (10.7) | 200 (14.7) | 0.001 | 277 (3.9) | 281 (4.7) | 0.043 |
Death—n (%) | 201 (13.6) | 215 (17.9) | 0.002 | 303 (4.8) | 308 (5.7) | 0.03 |
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De Luca, G.; Algowhary, M.; Uguz, B.; Oliveira, D.C.; Ganyukov, V.; Busljetik, O.; Cercek, M.; Jensen, L.O.; Loh, P.H.; Calmac, L.; et al. Age-Related Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI: Results of the ISACS-STEMI COVID-19 Registry. J. Clin. Med. 2023, 12, 2116. https://doi.org/10.3390/jcm12062116
De Luca G, Algowhary M, Uguz B, Oliveira DC, Ganyukov V, Busljetik O, Cercek M, Jensen LO, Loh PH, Calmac L, et al. Age-Related Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI: Results of the ISACS-STEMI COVID-19 Registry. Journal of Clinical Medicine. 2023; 12(6):2116. https://doi.org/10.3390/jcm12062116
Chicago/Turabian StyleDe Luca, Giuseppe, Magdy Algowhary, Berat Uguz, Dinaldo C. Oliveira, Vladimir Ganyukov, Oliver Busljetik, Miha Cercek, Lisette Okkels Jensen, Poay Huan Loh, Lucian Calmac, and et al. 2023. "Age-Related Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI: Results of the ISACS-STEMI COVID-19 Registry" Journal of Clinical Medicine 12, no. 6: 2116. https://doi.org/10.3390/jcm12062116