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

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.

Trends in primary percutaneous coronary intervention for the treatment of acute coronary ST-elevation myocardial infarction in Latin American countries: insights from the CECI consortium

“…The rate of in-stent thrombosis as a cause of STEMI was 7.5% in our cohort, slightly higher than the incidence of 5.1% found in elderly patients in the worldwide ISAC-STEMI COVID-19 Registry (9). Given that none of them were due to an acute event, the lack of intracoronary imaging in our series did not allow us to assess the pathophysiology of stent thrombosis.…”

“…Since the COMPLETE Trial (Complete vs. Culprit-Only Revascularization Strategies to Treat Multivessel Disease after Early PCI for STEMI), current guidelines recommend complete revascularization as the standard treatment for patients with STEMI and multivessel disease, excluding those with cardiogenic shock (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). In our trial, we report a complete revascularization rate of 82.8%.…”

“…The ISAC-STEMI COVID-19 Registry (The International Study on Acute Coronary Syndromes-ST-elevation myocardial infarction), a multinational collaboration from high-volume centers during the COVID-19 pandemic, provided insights into the treatment and outcomes of STEMI patients, reporting a median door-to-balloon time of 40 min (with 70% within 60 min) and an in-hospital mortality rate of 3.9% in 2019 (7)(8)(9). Similar findings were observed in a contemporary meta-analysis, where pPCI demonstrated an in-hospital mortality rate of 4.8% (9). During the COVID-19 pandemic, we did not analyze outcomes based on COVID-19 positivity in STEMI patients or investigate differences related to night shifts.…”

Multifaceted Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on ST-Elevation Myocardial Infarction (STEMI): A Literature Review of Incidence, Treatment Modalities, and Outcomes

“…The inability to follow personal protective measures could have only increased the risk fourfold in such patients [57]. The higher thrombotic and bleeding risk in elderly patients, coupled with worse periprocedural outcome, has been reported in previous studies [56]. Moreover, age has been identified as an independent predictor of mortality in STEMI patients with concurrent COVID-19.…”

“…These patients have higher 30-day mortality [ 55 ]. Elderly patients are known to have a higher thrombotic and bleeding risk and worse periprocedural outcome, which makes them more susceptible to the deleterious direct and indirect effects of COVID-19 [ 56 ]. During the pandemic, longer ischemia time and rates of late presentation were observed in both young and elderly patients.…”