Diabet Epidemiol Manag
. Oct-Dec 2021;4:100022.
doi: 10.1016/j.deman.2021.100022. Epub 2021 Oct 30.
Renin-angiotensin system inhibitors and mortality among diabetic patients with STEMI undergoing mechanical reperfusion during the COVID-19 pandemic
Giuseppe De Luca 1 , Matteo Nardin 2 , Magdy Algowhary 3 , Berat Uguz 4 , Dinaldo C Oliveira 5 , Vladimir Ganyukov 6 , Zan Zimbakov 7 , Miha Cercek 8 , Lisette Okkels Jensen 9 , Poay Huan Loh 10 , Lucian Calmac 11 , Gerard Roura Ferrer 12 , Alexandre Quadros 13 , Marek Milewski 14 , Fortunato Scotto di Uccio 15 , Clemens von Birgelen 16 , Francesco Versaci 17 , Jurrien Ten Berg 18 , Gianni Casella 19 , Aaron Wong Sung Lung 20 , Petr Kala 21 , José Luis Díez Gil 22 , Xavier Carrillo 23 , Maurits Dirksen 24 , Victor M Becerra-Munoz 25 , Michael Kang-Yin Lee 26 , Dafsah Arifa Juzar 27 , Rodrigo de Moura Joaquim 28 , Roberto Paladino 29 , Davor Milicic 30 , Periklis Davlouros 31 , Nikola Bakraceski 32 , Filippo Zilio 33 , Luca Donazzan 34 , Adriaan Kraaijeveld 35 , Gennaro Galasso 36 , Arpad Lux 37 , Lucia Marinucci 38 , Vincenzo Guiducci 39 , Maurizio Menichelli 40 , Alessandra Scoccia 41 , Aylin Hatice Yamac 42 , Kadir Ugur Mert 43 , Xacobe Flores Rios 44 , Tomas Kovarnik 45 , Michal Kidawa 46 , Josè Moreu 47 , Vincent Flavien 48 , Enrico Fabris 49 , Iñigo Lozano Martínez-Luengas 50 , Marco Boccalatte 51 , Francisco Bosa Ojeda 52 , Carlos Arellano-Serrano 53 , Gianluca Caiazzo 54 , Giuseppe Cirrincione 55 , Hsien-Li Kao 56 , Juan Sanchis Forés 57 , Luigi Vignali 58 , Helder Pereira 59 , Stephane Manzo 60 , Santiago Ordoñez 61 , Alev Arat Özkan 62 , Bruno Scheller 63 , Heidi Lehtola 64 , Rui Teles 65 , Christos Mantis 66 , Ylitalo Antti 67 , João António Brum Silveira 68 , Rodrigo Zoni 69 , Ivan Bessonov 70 , Stefano Savonitto 71 , George Kochiadakis 72 , Dimitrios Alexopulos 73 , Carlos E Uribe 74 , John Kanakakis 75 , Benjamin Faurie 76 , Gabriele Gabrielli 77 , Alejandro Gutierrez Barrios 78 , Juan Pablo Bachini 79 , Alex Rocha 80 , Frankie Chor-Cheung Tam 81 , Alfredo Rodriguez 82 , Antonia Anna Lukito 83 , Veauthyelau Saint-Joy 84 , Gustavo Pessah 85 , Andrea Tuccillo 15 , Giuliana Cortese 86 , Guido Parodi 87 , Mohammed Abed Bouraghda 88 , Elvin Kedhi 89 , Pablo Lamelas 90 , Harry Suryapranata 91 , Monica Verdoia 91
Affiliations
- PMID: 35072135
- PMCID: PMC8556094
- DOI: 10.1016/j.deman.2021.100022
Abstract
Background: During the coronavirus disease 2019 (COVID-19) pandemic, concerns have been arisen on the use of renin-angiotensin system inhibitors (RASI) due to the potentially increased expression of Angiotensin-converting-enzyme (ACE)2 and patient's susceptibility to SARS-CoV2 infection. Diabetes mellitus have been recognized favoring the coronavirus infection with consequent increase mortality in COVID-19. No data have been so far reported in diabetic patients suffering from ST-elevation myocardial infarction (STEMI), a very high-risk population deserving of RASI treatment.
Methods: The ISACS-STEMI COVID-19 registry retrospectively assessed STEMI patients treated with primary percutaneous coronary intervention (PPCI) in March/June 2019 and 2020 in 109 European high-volume primary PCI centers. This subanalysis assessed the prognostic impact of chronic RASI therapy at admission on mortality and SARS-CoV2 infection among diabetic patients.
Results: Our population is represented by 3812 diabetic STEMI patients undergoing mechanical reperfusion, 2038 in 2019 and 1774 in 2020. Among 3761 patients with available data on chronic RASI therapy, between those ones with and without treatment there were several differences in baseline characteristics, (similar in both periods) but no difference in the prevalence of SARS-CoV2 infection (1.6% vs 1.3%, respectively, p = 0.786). Considering in-hospital medication, RASI therapy was overall associated with a significantly lower in-hospital mortality (3.3% vs 15.8%, p < 0.0001), consistently both in 2019 and in 2010.
Conclusions: This is first study to investigate the impact of RASI therapy on prognosis and SARS-CoV2 infection of diabetic patients experiencing STEMI and undergoing PPCI during the COVID-19 pandemic. Both pre-admission chronic RASI therapy and in-hospital RASI did not negatively affected patients' survival during the hospitalization, neither increased the risk of SARS-CoV2 infection