Renin-angiotensin system inhibitors and mortality among diabetic patients with STEMI undergoing mechanical reperfusion during the COVID-19 pandemic.

Fecha de publicación: 30/10/2021 Fecha Ahead of Print: 30/10/2021

Autores de IIS La Fe

José Luis Díez Gil

Autor

Participantes ajenos a IIS La Fe

De Luca G
Nardin M
Algowhary M
Uguz B
Oliveira DC
Ganyukov V
Zimbakov Z
Cercek M
Jensen LO
Loh PH
Calmac L
Roura Ferrer G
Quadros A
Milewski M
Scotto di Uccio F
von Birgelen C
Versaci F
Ten Berg J
Casella G
Lung AWS
Kala P
Carrillo X
Dirksen M
Becerra-Munoz VM
Lee MK
Juzar DA
de Moura Joaquim R
Paladino R
Milicic D
Davlouros P
Bakraceski N
Zilio F
Donazzan L
Kraaijeveld A
Galasso G
Lux A
Marinucci L
Guiducci V
Menichelli M
Scoccia A
Yamac AH
Mert KU
Flores Rios X
Kovarnik T
Kidawa M
Moreu J
Flavien V
Fabris E
Martínez-Luengas IL
Boccalatte M
Bosa Ojeda F
Arellano-Serrano C
Caiazzo G
Cirrincione G
Kao HL
Sanchis Forés J
Vignali L
Pereira H
Manzo S
Ordoñez S
Arat Özkan A
Scheller B
Lehtola H
Teles R
Mantis C
Antti Y
Brum Silveira JA
Zoni R
Bessonov I
Savonitto S
Kochiadakis G
Alexopulos D
Uribe CE
Kanakakis J
Faurie B
Gabrielli G
Gutierrez Barrios A
Bachini JP
Rocha A
Tam FC
Rodriguez A
Lukito AA
Saint-Joy V
Pessah G
Tuccillo A
Cortese G
Parodi G
Bouraghda MA
Kedhi E
Lamelas P
Suryapranata H
Verdoia M

Grupos

Grupo de Investigación Clínica y Traslacional en Cardiología

Investigador Principal

Esther Roselló Lletí

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. TRIAL REGISTRATION NUMBER: NCT04412655.