Division of Cardiology, Azienda Ospedaliero-Universitaria Maggiore della Carità, Università del Piemonte Orientale, Novara, Italy.
Centre for Intensive Internal Medicine, University Medical Centre, Ljubljana, Slovenia.
Cardiovasc Diabetol. 2020 Dec 18;19(1):215. doi: 10.1186/s12933-020-01196-0.
It has been suggested the COVID pandemic may have indirectly affected the treatment and outcome of STEMI patients, by avoidance or significant delays in contacting the emergency system. No data have been reported on the impact of diabetes on treatment and outcome of STEMI patients, that was therefore the aim of the current subanalysis conducted in patients included in the International Study on Acute Coronary Syndromes-ST Elevation Myocardial Infarction (ISACS-STEMI) COVID-19.
The ISACS-STEMI COVID-19 is a retrospective registry performed in European centers with an annual volume of > 120 primary percutaneous coronary intervention (PCI) and assessed STEMI patients, treated with primary PCI during the same periods of the years 2019 versus 2020 (March and April). Main outcomes are the incidences of primary PCI, delayed treatment, and in-hospital mortality.
A total of 6609 patients underwent primary PCI in 77 centers, located in 18 countries. Diabetes was observed in a total of 1356 patients (20.5%), with similar proportion between 2019 and 2020. During the pandemic, there was a significant reduction in primary PCI as compared to 2019, similar in both patients with (Incidence rate ratio (IRR) 0.79 (95% CI: 0.73-0.85, p < 0.0001) and without diabetes (IRR 0.81 (95% CI: 0.78-0.85, p < 0.0001) (p int = 0.40). We observed a significant heterogeneity among centers in the population with and without diabetes (p < 0.001, respectively). The heterogeneity among centers was not related to the incidence of death due to COVID-19 in both groups of patients. Interaction was observed for Hypertension (p = 0.024) only in absence of diabetes. Furthermore, the pandemic was independently associated with a significant increase in door-to-balloon and total ischemia times only among patients without diabetes, which may have contributed to the higher mortality, during the pandemic, observed in this group of patients.
The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a similar reduction in primary PCI procedures in both patients with and without diabetes. Hypertension had a significant impact on PCI reduction only among patients without diabetes. We observed a significant increase in ischemia time and door-to-balloon time mainly in absence of diabetes, that contributed to explain the increased mortality observed in this group of patients during the pandemic.
NCT04412655.
有人认为，COVID-19 大流行可能通过避免或严重延迟与急救系统联系，间接影响 STEMI 患者的治疗和预后。目前尚未有关于糖尿病对 STEMI 患者治疗和预后影响的报告，因此，这是在国际急性冠状动脉综合征-ST 段抬高型心肌梗死（ISACS-STEMI）COVID-19 中纳入的患者中进行的当前亚分析的目的。
ISACS-STEMI COVID-19 是一项在每年行 120 例以上直接经皮冠状动脉介入治疗（PCI）的欧洲中心进行的回顾性登记，评估了在 2019 年和 2020 年（3 月和 4 月）同一时期接受直接 PCI 治疗的 STEMI 患者。主要结局是直接 PCI、延迟治疗和院内死亡率的发生率。
共有 6609 例患者在 77 个中心接受了直接 PCI，这些中心分布在 18 个国家。共有 1356 例（20.5%）患者存在糖尿病，2019 年和 2020 年的比例相似。在大流行期间，与 2019 年相比，直接 PCI 的数量明显减少，在有和无糖尿病的患者中相似（发生率比 0.79（95%CI：0.73-0.85，p<0.0001）和 0.81（95%CI：0.78-0.85，p<0.0001）（pint=0.40）。我们观察到有和无糖尿病的患者在中心之间存在显著的异质性（p<0.001，分别）。两组患者的中心间异质性与 COVID-19 导致的死亡率无关（p<0.001）。在无糖尿病的患者中观察到高血压（p=0.024）存在交互作用。此外，大流行与无糖尿病患者的门球时间和总缺血时间显著增加独立相关，这可能导致该组患者在大流行期间观察到的死亡率更高。
COVID-19 大流行对 STEMI 患者的治疗产生了重大影响，有和无糖尿病的患者的直接 PCI 治疗均显著减少。高血压仅在无糖尿病的患者中对 PCI 减少有显著影响。我们主要在无糖尿病的患者中观察到缺血时间和门球时间的显著增加，这有助于解释该组患者在大流行期间观察到的死亡率增加。
NCT04412655。
