tetano
Editor, Senior Moderator
Biomed Pharmacother
. 2021 Mar 16;138:111469.
doi: 10.1016/j.biopha.2021.111469. Online ahead of print.
Impact of renin-angiotensin system inhibitors on mortality during the COVID Pandemic among STEMI patients undergoing mechanical reperfusion: Insight from an international STEMI registry
Giuseppe De Luca[SUP] 1 [/SUP], Miha Cercek[SUP] 2 [/SUP], Lisette Okkels Jensen[SUP] 3 [/SUP], Oliver Bushljetikj[SUP] 4 [/SUP], Lucian Calmac[SUP] 5 [/SUP], Tom Johnson[SUP] 6 [/SUP], Montserrat Gracida Blancas[SUP] 7 [/SUP], Vladimir Ganyukov[SUP] 8 [/SUP], Wojtek Wojakowski[SUP] 9 [/SUP], Clemens von Birgelen[SUP] 10 [/SUP], Alexander IJsselmuiden[SUP] 11 [/SUP], Bernardo Tuccillo[SUP] 12 [/SUP], Francesco Versaci[SUP] 13 [/SUP], Jurrien Ten Berg[SUP] 14 [/SUP], Mika Laine[SUP] 15 [/SUP], Tim Berkout[SUP] 16 [/SUP], Gianni Casella[SUP] 17 [/SUP], Petr Kala[SUP] 18 [/SUP], Bernab? L?pez Ledesma[SUP] 19 [/SUP], Victor Becerra[SUP] 20 [/SUP], Roberto Padalino[SUP] 21 [/SUP], Andrea Santucci[SUP] 22 [/SUP], Xavier Carrillo[SUP] 23 [/SUP], Alessandra Scoccia[SUP] 24 [/SUP], Giovanni Amoroso[SUP] 25 [/SUP], Arpad Lux[SUP] 26 [/SUP], Tomas Kovarnik[SUP] 27 [/SUP], Periklis Davlouros[SUP] 28 [/SUP], Gabriele Gabrielli[SUP] 29 [/SUP], Xacobe Flores Rios[SUP] 30 [/SUP], Nikola Bakraceski[SUP] 31 [/SUP], S?bastien Levesque[SUP] 32 [/SUP], Vincenzo Guiducci[SUP] 33 [/SUP], Micha? Kidawa[SUP] 34 [/SUP], Lucia Marinucci[SUP] 35 [/SUP], Filippo Zilio[SUP] 36 [/SUP], Gennaro Galasso[SUP] 37 [/SUP], Enrico Fabris[SUP] 38 [/SUP], Maurizio Menichelli[SUP] 39 [/SUP], Stephane Manzo[SUP] 40 [/SUP], Gianluca Caiazzo[SUP] 41 [/SUP], Jose Moreu[SUP] 42 [/SUP], Juan Sanchis For?s[SUP] 43 [/SUP], Luca Donazzan[SUP] 44 [/SUP], Luigi Vignali[SUP] 45 [/SUP], Rui Teles[SUP] 46 [/SUP], Pierfrancesco Agostoni[SUP] 47 [/SUP], Francisco Bosa Ojeda[SUP] 48 [/SUP], Heidi Lehtola[SUP] 49 [/SUP], Santiago Camacho-Freiere[SUP] 50 [/SUP], Adriaan Kraaijeveld[SUP] 51 [/SUP], Ylitalo Antti[SUP] 52 [/SUP], Gabriella Visconti[SUP] 53 [/SUP], I?igo Lozano Mart?nez-Luengas[SUP] 54 [/SUP], Bruno Scheller[SUP] 55 [/SUP], Dimitrios Alexopulos[SUP] 56 [/SUP], Raul Moreno[SUP] 57 [/SUP], Elvin Kedhi[SUP] 58 [/SUP], Giuseppe Uccello[SUP] 59 [/SUP], Benjamin Faurie[SUP] 60 [/SUP], Alejandro Gutierrez Barrios[SUP] 61 [/SUP], Fortunato Scotto Di Uccio[SUP] 12 [/SUP], Bor Wilbert[SUP] 14 [/SUP], Giuliana Cortese[SUP] 62 [/SUP], Maurits T Dirksen[SUP] 16 [/SUP], Guido Parodi[SUP] 63 [/SUP], Monica Verdoia[SUP] 64 [/SUP]
Affiliations
Abstract
Background: Concerns have been raised on a potential interaction between renin-angiotensin system inhibitors (RASI) and the susceptibility to coronavirus disease 2019 (COVID-19). No data have been so far reported on the prognostic impact of RASI in patients suffering from ST-elevation myocardial infarction (STEMI) during COVID-19 pandemic, which was the aim of the present study.
Methods: STEMI patients treated with primary percutaneous coronary intervention (PPCI) and enrolled in the ISACS-STEMI COVID-19 registry were included in the present sub-analysis and divided according to RASI therapy at admission.
Results: Our population is represented by 6095 patients, of whom 3654 admitted in 2019 and 2441 in 2020. No difference in the prevalence of SARSCoV2 infection was observed according to RASI therapy at admission (2.5% vs 2.1%, p = 0.5), which was associated with a significantly lower mortality (adjusted OR [95% CI]=0.68 [0.51-0.90], P = 0.006), confirmed in the analysis restricted to 2020 (adjusted OR [95% CI]=0.5[0.33-0.74], P = 0.001). Among the 5388 patients in whom data on in-hospital medication were available, in-hospital RASI therapy was associated with a significantly lower mortality (2.1% vs 16.7%, OR [95% CI]=0.11 [0.084-0.14], p < 0.0001), confirmed after adjustment in both periods. Among the 62 SARSCoV-2 positive patients, RASI therapy, both at admission or in-hospital, showed no prognostic effect.
Conclusions: This is the first study to investigate the impact of RASI therapy on the prognosis and SARSCoV2 infection of STEMI patients undergoing PPCI during the COVID-19 pandemic. Both pre-admission and in-hospital RASI were associated with lower mortality. Among SARSCoV2-positive patients, both chronic and in-hospital RASI therapy showed no impact on survival.
Keywords: COVID-19; Mortality; Percutaneous coronary intervention; Renin-Angiotensin System inhibitors; ST-segment elevation myocardial infarction.
. 2021 Mar 16;138:111469.
doi: 10.1016/j.biopha.2021.111469. Online ahead of print.
Impact of renin-angiotensin system inhibitors on mortality during the COVID Pandemic among STEMI patients undergoing mechanical reperfusion: Insight from an international STEMI registry
Giuseppe De Luca[SUP] 1 [/SUP], Miha Cercek[SUP] 2 [/SUP], Lisette Okkels Jensen[SUP] 3 [/SUP], Oliver Bushljetikj[SUP] 4 [/SUP], Lucian Calmac[SUP] 5 [/SUP], Tom Johnson[SUP] 6 [/SUP], Montserrat Gracida Blancas[SUP] 7 [/SUP], Vladimir Ganyukov[SUP] 8 [/SUP], Wojtek Wojakowski[SUP] 9 [/SUP], Clemens von Birgelen[SUP] 10 [/SUP], Alexander IJsselmuiden[SUP] 11 [/SUP], Bernardo Tuccillo[SUP] 12 [/SUP], Francesco Versaci[SUP] 13 [/SUP], Jurrien Ten Berg[SUP] 14 [/SUP], Mika Laine[SUP] 15 [/SUP], Tim Berkout[SUP] 16 [/SUP], Gianni Casella[SUP] 17 [/SUP], Petr Kala[SUP] 18 [/SUP], Bernab? L?pez Ledesma[SUP] 19 [/SUP], Victor Becerra[SUP] 20 [/SUP], Roberto Padalino[SUP] 21 [/SUP], Andrea Santucci[SUP] 22 [/SUP], Xavier Carrillo[SUP] 23 [/SUP], Alessandra Scoccia[SUP] 24 [/SUP], Giovanni Amoroso[SUP] 25 [/SUP], Arpad Lux[SUP] 26 [/SUP], Tomas Kovarnik[SUP] 27 [/SUP], Periklis Davlouros[SUP] 28 [/SUP], Gabriele Gabrielli[SUP] 29 [/SUP], Xacobe Flores Rios[SUP] 30 [/SUP], Nikola Bakraceski[SUP] 31 [/SUP], S?bastien Levesque[SUP] 32 [/SUP], Vincenzo Guiducci[SUP] 33 [/SUP], Micha? Kidawa[SUP] 34 [/SUP], Lucia Marinucci[SUP] 35 [/SUP], Filippo Zilio[SUP] 36 [/SUP], Gennaro Galasso[SUP] 37 [/SUP], Enrico Fabris[SUP] 38 [/SUP], Maurizio Menichelli[SUP] 39 [/SUP], Stephane Manzo[SUP] 40 [/SUP], Gianluca Caiazzo[SUP] 41 [/SUP], Jose Moreu[SUP] 42 [/SUP], Juan Sanchis For?s[SUP] 43 [/SUP], Luca Donazzan[SUP] 44 [/SUP], Luigi Vignali[SUP] 45 [/SUP], Rui Teles[SUP] 46 [/SUP], Pierfrancesco Agostoni[SUP] 47 [/SUP], Francisco Bosa Ojeda[SUP] 48 [/SUP], Heidi Lehtola[SUP] 49 [/SUP], Santiago Camacho-Freiere[SUP] 50 [/SUP], Adriaan Kraaijeveld[SUP] 51 [/SUP], Ylitalo Antti[SUP] 52 [/SUP], Gabriella Visconti[SUP] 53 [/SUP], I?igo Lozano Mart?nez-Luengas[SUP] 54 [/SUP], Bruno Scheller[SUP] 55 [/SUP], Dimitrios Alexopulos[SUP] 56 [/SUP], Raul Moreno[SUP] 57 [/SUP], Elvin Kedhi[SUP] 58 [/SUP], Giuseppe Uccello[SUP] 59 [/SUP], Benjamin Faurie[SUP] 60 [/SUP], Alejandro Gutierrez Barrios[SUP] 61 [/SUP], Fortunato Scotto Di Uccio[SUP] 12 [/SUP], Bor Wilbert[SUP] 14 [/SUP], Giuliana Cortese[SUP] 62 [/SUP], Maurits T Dirksen[SUP] 16 [/SUP], Guido Parodi[SUP] 63 [/SUP], Monica Verdoia[SUP] 64 [/SUP]
Affiliations
- PMID: 33740523
- PMCID: PMC7962982
- DOI: 10.1016/j.biopha.2021.111469
Abstract
Background: Concerns have been raised on a potential interaction between renin-angiotensin system inhibitors (RASI) and the susceptibility to coronavirus disease 2019 (COVID-19). No data have been so far reported on the prognostic impact of RASI in patients suffering from ST-elevation myocardial infarction (STEMI) during COVID-19 pandemic, which was the aim of the present study.
Methods: STEMI patients treated with primary percutaneous coronary intervention (PPCI) and enrolled in the ISACS-STEMI COVID-19 registry were included in the present sub-analysis and divided according to RASI therapy at admission.
Results: Our population is represented by 6095 patients, of whom 3654 admitted in 2019 and 2441 in 2020. No difference in the prevalence of SARSCoV2 infection was observed according to RASI therapy at admission (2.5% vs 2.1%, p = 0.5), which was associated with a significantly lower mortality (adjusted OR [95% CI]=0.68 [0.51-0.90], P = 0.006), confirmed in the analysis restricted to 2020 (adjusted OR [95% CI]=0.5[0.33-0.74], P = 0.001). Among the 5388 patients in whom data on in-hospital medication were available, in-hospital RASI therapy was associated with a significantly lower mortality (2.1% vs 16.7%, OR [95% CI]=0.11 [0.084-0.14], p < 0.0001), confirmed after adjustment in both periods. Among the 62 SARSCoV-2 positive patients, RASI therapy, both at admission or in-hospital, showed no prognostic effect.
Conclusions: This is the first study to investigate the impact of RASI therapy on the prognosis and SARSCoV2 infection of STEMI patients undergoing PPCI during the COVID-19 pandemic. Both pre-admission and in-hospital RASI were associated with lower mortality. Among SARSCoV2-positive patients, both chronic and in-hospital RASI therapy showed no impact on survival.
Keywords: COVID-19; Mortality; Percutaneous coronary intervention; Renin-Angiotensin System inhibitors; ST-segment elevation myocardial infarction.