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Publications

Journal Article Ahead of print

PubMed: 42411222 DOI: 10.2174/0115701611415264260622061654

Chronic Treatment with Renin-Angiotensin System Inhibitors at Hospital Admission is Associated with Improved Reperfusion and Mortality Among STEMI Patients Undergoing Mechanical Reperfusion: Insight from the ISACS-STEMI COVID-19 Registry.

Curr Vasc Pharmacol

Authors: Giuseppe De Luca, Magdy Algowhary, Berat Uguz, Dinaldo Oliveira, Vladimir Ganyukov, Zan Zimbakov, Miha Cercek, Lisette Okkels Jensen, Poay Huan Loh, Lucian Calmac, Gerard Roura I Ferrer, Alexander Quadros, Marek Malewski, Fortunato Scotto Di Uccio, Clemens Von Birgelen, Francesco Versaci, Jurrien Ten Berg, Gianni Casella, Aaron Wong Sung Lung, Petr Kala, Jose Luis Díez Gil, Xavier Carrillo, Maurits Dirksen, Victor Manuel Becerra-Munoz, Michael Kang-Yin Lee, Dafsah Arifa Juzar, Rodrigo de Moura Joaquim, Roberto Paladino, Davor Milicic, Periklis Davlouros, Nikola Bakraceski, Filippo Zilio, Luca Donazzan, Adriaan Kraaijeveld, Gennaro Galasso, Arpad Lux, Lucia Marinucci, Vincenzo Guiducci, Maurizio Menichelli, Alessandra Scoccia, Aylin Hatice Yamac, Kadir Ugur Mert, Xacobe Flores Rios, Tomas Kovarnik, Michal Kidawa, Jose Moreu, Vincent Flavien, Enrico Fabris, Inigo Lozano Martínez-Luengas, Francisco Bosa Ojeda … and 41 other authors

Affiliations

  • Division of Cardiology, AOU "Policlinico G. Martino", Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
  • Division of Cardiology, Galeazzi-Sant'Ambrogio Hospital, Milan, Italy.
  • Division of Cardiology, Assiut University Heart Hospital, Assiut University, Asyut, Egypt.
  • Division of Cardiology, Bursa City Hospital,Bursa,Turke.
  • Pronto de Socorro Cardiologico Prof. Luis Tavares, Centro PROCAPE, Federal University of Pernambuco, Recife, Brasil.
  • Department of Heart and Vascular Surgery, State Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia.
  • University Clinic for Cardiology, Medical Faculty, Ss' Cyril and Methodius University, Skopje, North Macedonia.
  • Centre for Intensive Internal Medicine, University Medical Centre, Ljubljana, Slovenia.
  • Division of Cardiology, Odense Universitets Hospital, Odense, Danemark.
  • Department of Cardiology, National University Hospital, Singapore.
  • Clinic Emergency Hospital of Bucharest, Romania.
  • Interventional Cardiology Unit, Heart Disease Institute. Hospital Universitari de Bellvitge, Barcelona Spain.
  • Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre; Brazil.
  • Division of Cardiology, Medical University of Silezia, Katowice, Poland.
  • Division of Cardiology,Ospedale del Mare, Napoli, Italy.
  • Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, The Netherlands.
  • Division of Cardiology, Ospedale Santa Maria Goretti Latina, Italy.
  • Division of Cardiology, St Antonius Hospital, Nieuwegein, The Netherland.
  • Division of Cardiology, Ospedale Maggiore Bologna, Italy.
  • Department of Cardiology, National Heart Center, Singapore, Singapore, Singapore.
  • University Hospital Brno, Medical Faculty of Masaryk University Brno, Czech Republic, Brno, Czechia.
  • H. Universitario y Politécnico La Fe, Valencia, Spain.
  • Hospital Germans Triasi Pujol, Badalona, Spain.
  • Division of Cardiology, Northwest Clinics Alkmaar, The Netherlands.
  • Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
  • Department of Cardiology, Queen Elizabeth Hospital, University of Hong Kong, Hong Kong.
  • Department of cardiology and Vascular Medicine, University of Indonesia National Cardiovascular Center "Harapan Kita", Jakarta.
  • Instituto de Cardiologia de Santa Catarina Praia Comprida, São José, Brasil.
  • Division of Cardiology, Clinica Villa dei Fiori, Acerra, Italy.
  • Department of Cardiology, University Hospital Centre, University of Zagreb, Zagreb, Croatia.
  • Invasive Cardiology and Congenital Heart Disease, Patras University Hospital, Patras; Greece.
  • Center for Cardiovascular Diseases, Ohrid, North Macedonia.
  • Division of Cardiology, Ospedale Santa Chiara di Trento, Trento, Italy.
  • Division of Cardiology, Ospedale "S. Maurizio" Bolzano Italy.
  • Division of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
  • Division of Cardiology, Ospedale San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
  • Maastricht University Medical Centre, Maastricht, Netherlands.
  • Division of Cardiology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Pesaro, Italy.
  • Division of Cardiology, AUSL-IRCCS Reggio Emilia, Italy.
  • Division of Cardiology, Ospedale "F. Spaziani", Frosinone, Italy.
  • Division of Cardiology, Ospedale "Sant'Anna", Ferrara, Italy.
  • Department of Cardiology, Hospital Bezmialem Vakıf University, İstanbul, Turkiye.
  • Division of Cardiology, Eskisehir Osmangazi University, Faculty of Medicine, Eskisehir, Turkiye.
  • Complexo Hospetaliero Universitario La Coruna, La Coruna, Spain.
  • University Hospital Prague, Prague, Czechia.
  • Central Hospital of Medical University of Lodz, Lodz, Poland.
  • Division of Cardiology, Complejo Hospitalario de Toledo, Toledo, Spain.
  • Division of Cardiology, Center Hospitalier Universitaire de Lille, Lille, France.
  • Azienda Ospedaliero - Universitaria Ospedali Riuniti Trieste, Trieste Italy.
  • Division of Cardiology, Hospital de Cabueñes, Gijon, Spain.
  • Division of Cardiology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.

Abstract

INTRODUCTION

Despite the large use of renin-angiotensin system inhibitors (RASI) in STSegment Elevation Myocardial Infarction (STEMI) patients, few data have been reported on the prognostic impact of chronic RASI at admission in patients suffering from STEMI, especially during the COVID-19 pandemic. Therefore, the current study investigated the prognostic impact of chronic RASI at admission in patients suffering from STEMI, including both SARS-CoV-2 positive and negative individuals, enrolled before and during the COVID-19 pandemic.

METHODS

We included STEMI patients who received primary percutaneous coronary intervention (PPCI) and were enrolled in the ISACS-STEMI COVID-19 registry. In the present sub-analysis, patients were allocated according to chronic RASI therapy at admission. The primary study endpoint was the occurrence of in-hospital mortality. Secondary endpoints were postprocedural TIMI 3 flow and mortality at 1 month.

RESULTS

The overall population was 15,693 patients, including 6,213 patients pretreated with RASI. Several differences in baseline characteristics were observed between the two groups. No difference was observed in the prevalence of SARS-CoV-2 infection. After correction for all baseline confounders, including procedural features, chronic pretreatment with RASI was independently associated with improved postprocedural TIMI 3 flow (OR [95% CI] = 1.14 [1.03-1.35], p = 0.042), lower in-hospital mortality (adjusted OR [95% CI] = 0.64 [0.54-0.75], p < 0.001), and lower 30-day mortality (adjusted OR [95% CI] = 0.62 [0.53-0.73], p < 0.001).

CONCLUSION

This is the largest study investigating the prognostic impact and benefits of chronic RASI pre-treatment in STEMI patients undergoing PPCI, including those treated during the COVID19 pandemic. We found that chronic RASI treatment at hospital admission was associated with significant improvement in reperfusion and reduction in mortality, without any negative effect in SARS-CoV-2 positive patients. Results should be interpreted considering the retrospective, nonrandomized nature of the study.

MeSH

Registries, Mortality, Hospital Mortality, Renin, Angiotensins, St Elevation Myocardial Infarction, Covid-19, Reperfusion, Pandemics, Therapeutics, Renin-Angiotensin System