tetano
Editor, Senior Moderator
Eur J Intern Med
. 2022 Aug 18;S0953-6205(22)00298-9.
doi: 10.1016/j.ejim.2022.08.021. Online ahead of print.
Angiographic and clinical outcome of SARS-CoV-2 positive patients with ST-segment elevation myocardial infarction undergoing primary angioplasty: A collaborative, individual patient data meta-analysis of six registry-based studies
Giuseppe De Luca[SUP] 1 [/SUP], Angelo Silverio[SUP] 2 [/SUP], Monica Verdoia[SUP] 3 [/SUP], Zbigniew Siudak[SUP] 4 [/SUP], Tomasz Tokarek[SUP] 5 [/SUP], Thomas A Kite[SUP] 6 [/SUP], Anthony H Gershlick[SUP] 6 [/SUP], Oriol Rodriguez-Leor[SUP] 7 [/SUP], Belen Cid-Alvarez[SUP] 8 [/SUP], Daniel A Jones[SUP] 9 [/SUP], Krishnaraj S Rathod[SUP] 9 [/SUP], José M Montero-Cabezas[SUP] 10 [/SUP], Alfonso Jurado-Roman[SUP] 11 [/SUP], Matteo Nardin[SUP] 12 [/SUP], Gennaro Galasso[SUP] 2 [/SUP]
Affiliations
Abstract
Background: The characteristics and outcome of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients with ST-Elevation Myocardial Infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) are still poorly known.
Methods: The PANDEMIC study was an investigator-initiated, collaborative, individual patient data (IPD) meta-analysis of registry-based studies. MEDLINE, ScienceDirect, Web of Sciences, and SCOPUS were searched to identify all registry-based studies describing the characteristics and outcome of SARS-CoV-2-positive STEMI patients undergoing PPCI. The control group consisted of SARS-CoV-2-negative STEMI patients undergoing PPCI in the same time period from the ISACS-STEMI COVID 19 registry. The primary outcome was in-hospital mortality; the secondary outcome was postprocedural reperfusion assessed by TIMI flow.
Results: Of 8 registry-based studies identified, IPD were obtained from 6 studies including 941 SARS-CoV-2-positive patients; the control group included 2005 SARS-CoV-2-negative patients. SARS-CoV-2-positive patients showed a significantly higher in-hospital mortality (p < 0.001) and worse postprocedural TIMI flow (<3, p < 0.001) compared with SARS-CoV-2-negative subjects. The increased risk for SARS-CoV-2-positive patients was significantly higher in males compared to females for both the primary (p[SUB]interaction[/SUB] = 0.001) and secondary outcome (p[SUB]interaction[/SUB] = 0.023). In SARS-CoV-2-positive patients, age ≥ 75 years (OR = 5.72; 95%CI: 1.77-18.5), impaired postprocedural TIMI flow (OR = 11.72; 95%CI: 2.64-52.10), and cardiogenic shock at presentation (OR = 11.02; 95%CI: 2.84-42.80) were independent predictors of mortality.
Conclusions: In STEMI patients undergoing PPCI, SARS-CoV-2 positivity is independently associated with impaired reperfusion and with a higher risk of in-hospital mortality, especially among male patients. Age ≥ 75 years, cardiogenic shock, and impaired postprocedural TIMI flow independently predict mortality in this high-risk population.
Keywords: COVID-19; Coronavirus disease 2019; Mortality; Myocardial infarction; Outcome.
. 2022 Aug 18;S0953-6205(22)00298-9.
doi: 10.1016/j.ejim.2022.08.021. Online ahead of print.
Angiographic and clinical outcome of SARS-CoV-2 positive patients with ST-segment elevation myocardial infarction undergoing primary angioplasty: A collaborative, individual patient data meta-analysis of six registry-based studies
Giuseppe De Luca[SUP] 1 [/SUP], Angelo Silverio[SUP] 2 [/SUP], Monica Verdoia[SUP] 3 [/SUP], Zbigniew Siudak[SUP] 4 [/SUP], Tomasz Tokarek[SUP] 5 [/SUP], Thomas A Kite[SUP] 6 [/SUP], Anthony H Gershlick[SUP] 6 [/SUP], Oriol Rodriguez-Leor[SUP] 7 [/SUP], Belen Cid-Alvarez[SUP] 8 [/SUP], Daniel A Jones[SUP] 9 [/SUP], Krishnaraj S Rathod[SUP] 9 [/SUP], José M Montero-Cabezas[SUP] 10 [/SUP], Alfonso Jurado-Roman[SUP] 11 [/SUP], Matteo Nardin[SUP] 12 [/SUP], Gennaro Galasso[SUP] 2 [/SUP]
Affiliations
- PMID: 35999094
- DOI: 10.1016/j.ejim.2022.08.021
Abstract
Background: The characteristics and outcome of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients with ST-Elevation Myocardial Infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) are still poorly known.
Methods: The PANDEMIC study was an investigator-initiated, collaborative, individual patient data (IPD) meta-analysis of registry-based studies. MEDLINE, ScienceDirect, Web of Sciences, and SCOPUS were searched to identify all registry-based studies describing the characteristics and outcome of SARS-CoV-2-positive STEMI patients undergoing PPCI. The control group consisted of SARS-CoV-2-negative STEMI patients undergoing PPCI in the same time period from the ISACS-STEMI COVID 19 registry. The primary outcome was in-hospital mortality; the secondary outcome was postprocedural reperfusion assessed by TIMI flow.
Results: Of 8 registry-based studies identified, IPD were obtained from 6 studies including 941 SARS-CoV-2-positive patients; the control group included 2005 SARS-CoV-2-negative patients. SARS-CoV-2-positive patients showed a significantly higher in-hospital mortality (p < 0.001) and worse postprocedural TIMI flow (<3, p < 0.001) compared with SARS-CoV-2-negative subjects. The increased risk for SARS-CoV-2-positive patients was significantly higher in males compared to females for both the primary (p[SUB]interaction[/SUB] = 0.001) and secondary outcome (p[SUB]interaction[/SUB] = 0.023). In SARS-CoV-2-positive patients, age ≥ 75 years (OR = 5.72; 95%CI: 1.77-18.5), impaired postprocedural TIMI flow (OR = 11.72; 95%CI: 2.64-52.10), and cardiogenic shock at presentation (OR = 11.02; 95%CI: 2.84-42.80) were independent predictors of mortality.
Conclusions: In STEMI patients undergoing PPCI, SARS-CoV-2 positivity is independently associated with impaired reperfusion and with a higher risk of in-hospital mortality, especially among male patients. Age ≥ 75 years, cardiogenic shock, and impaired postprocedural TIMI flow independently predict mortality in this high-risk population.
Keywords: COVID-19; Coronavirus disease 2019; Mortality; Myocardial infarction; Outcome.