Impact of diabetes on epicardial reperfusion and mortality in a contemporary STEMI population undergoing mechanical reperfusion: insights from the ISACS STEMI COVID 19 Registry
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 i Ferrer; Gerard; Quadros, Alexandre; Milewski, Marek; D’Uccio, Fortunato Scotto; von Birgelen, Clemens; Versaci, Francesco; Berg, Jurrien Ten; Casella, Gianni; Lung; Aaron Wong Sung; Kala, Petr; Díez Gil; José Luis; Carrillo, Xavier; Dirksen, Maurits; Becerra-Munoz, Victor M.; Lee, Michael Kang-yin; Juzar, Dafsah Arifa; Moura; Joaquim Rodrigo de; Paladino, Roberto; Milicic, Davor; Davlouros, Periklis; Bakraceski, Nikola; Zilio, Filippo; Donazzan, Luca; Kraaijeveld, Adriaan; Galasso, Gennaro; Arpad, Lux; Marinucci, Lucia; Guiducci, Vincenzo; Menichelli, Maurizio; Scoccia, Alessandra; Yamac, Aylin Hatice; Mert, Kadir Ugur; Rios, Xacobe Flores; Kovarnik, Tomas; Kidawa, Michal; Moreu, José; Vincent, Flavien; Fabris, Enrico; Martínez-Luengas, Iñigo Lozano; Ojeda, Francisco Bosa; Rodríguez-Sanchez, Robert; Caiazzo, Gianluca; Cirrincione, Giuseppe; Kao, Hsien-Li; Forés, Juan Sanchis; Vignali, Luigi; Pereira, Helder; Manzo, Stephane; Ordoñez, Santiago; Özkan, Alev Arat; Scheller, Bruno; Lehtola, Heidi; Teles, Rui; Mantis, Christos; Ylitalo, Antti; Silveira; João António Brum; Zoni, Rodrigo; Bessonov, Ivan; Savonitto, Stefano; Kochiadakis, George; Alexopulos, 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; Bellemain-Appaix, Anne; Pessah, Gustavo; Cortese, Giuliana; Parodi, Guido; Burgadha, Mohammed Abed; Kedhi, Elvin; Lamelas, Pablo; Suryapranata, Harry; Nardin, Matteo; Verdoia, Monica
https://urn.fi/URN:NBN:fi-fe202601216269
Tiivistelmä
Background and Aim
Diabetes has been shown in last decades to be associated with a significantly higher mortality among patients with ST‐segment elevation myocardial infarction (STEMI) treated with primary PCI (PPCI). Therefore, the aim of current study was to evaluate the impact of diabetes on times delays, reperfusion and mortality in a contemporary STEMI population undergoing PPCI, including treatment during the COVID pandemic.
Methods and Results
The ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry involving PPCI centers from Europe, Latin America, South-East Asia and North-Africa, including patients treated from 1st of March until June 30, 2019 and 2020. Primary study endpoint of this analysis was in-hospital mortality. Secondary endpoints were postprocedural TIMI 0-2 flow and 30-day mortality. Our population is represented by 16083 STEMI patients. A total of 3812 (23,7%) patients suffered from diabetes. They were older, more often males as compared to non-diabetes. Diabetic patients were less often active smokers and had less often a positive family history of CAD, but they were more often affected by hypertension and hypercholesterolemia, with higher prevalence of previous STEMI and previous CABG. Diabetic patients had longer ischemia time, had more often anterior MI, cardiogenic shock, rescue PCI and multivessel disease. They had less often out-of-hospital cardiac arrest and in-stent thrombosis, received more often a mechanical support, received less often a coronary stent and DES. Diabetes was associated with a significantly impaired postprocedural TIMI flow (TIMI 0-2: 9.8% vs 7.2%, adjusted OR [95% CI] = 1.17 [1.02-1.38], p = 0.024) and higher mortality (in-hospital: 9.1% vs 4.8%, Adjusted OR [95% CI] =1.70 [1.43-2.02], p < 0.001); 30-day mortality (10.8% vs 6%, Adjusted HR [95% CI] =1.46 [1.26-1.68], p < 0.001) as compared to non-diabetes, particularly during the pandemic.
Conclusions
Our study showed that in a contemporary STEMI population undergoing PPCI, diabetes is significantly associated with impaired epicardial reperfusion that translates into higher in-hospital and 30-day mortality, particularly during the pandemic.
Kokoelmat
- Rinnakkaistallenteet [29337]