Impact of diabetes on epicardial reperfusion and mortality in a contemporary STEMI population undergoing mechanical reperfusion: Insights from the ISACS STEMI COVID 19 registry.

Fecha de publicación: 24/10/2024

Autores de IIS La Fe

José Luis Díez Gil

Autor

Participantes ajenos a IIS La Fe

De Luca, Giuseppe
Algowhary, Magdy
Uguz, Berat
Oliveira, Dinaldo C
Ganyukov, Vladimir
Zimbakov, Zan
Cercek, Miha
Jensen, Lisette Okkels
Loh, Poay Huan
Calmac, Lucian
Roura I Ferrer, Gerard
Quadros, Alexandre
Milewski, Marek
D'Uccio, Fortunato Scotto
von Birgelen, Clemens
Versaci, Francesco
Berg, Jurrien Ten
Casella, Gianni
Lung, Aaron Wong Sung
Kala, Petr
Carrillo, Xavier
Dirksen, Maurits
Becerra-Munoz, Victor M
Lee, Michael Kang-Yin
Juzar, Dafsah Arifa
Moura Joaquim, Rodrigo de
Paladino, Roberto
Milicic, Davor
Davlouros, Periklis
Bakraceski, Nikola
Zilio, Filippo
Donazzan, Luca
Kraaijeveld, Adriaan
Galasso, Gennaro
Arpad, Lux
Lucia, Marinucci
Vincenzo, Guiducci
Menichelli, Maurizio
Scoccia, Alessandra
Yamac, Aylin Hatice
Mert, Kadir Ugur
Rios, Xacobe Flores
Kovarnik, Tomas
Kidawa, Michal
Moreu, Jose
Flavien, Vincent
Fabris, Enrico
Martinez-Luengas, Inigo Lozano
Ojeda, Francisco Bosa
Rodriguez-Sanchez, Robert
Caiazzo, Gianluca
Cirrincione, Giuseppe
Kao, Hsien-Li
Fores, Juan Sanchis
Vignali, Luigi
Pereira, Helder
Manzo, Stephane
Ordonez, Santiago
Ozkan, Alev Arat
Scheller, Bruno
Lehtola, Heidi
Teles, Rui
Mantis, Christos
Antti, Ylitalo
Silveira, Joao Antonio Brum
Zoni, Rodrigo
Bessonov, Ivan
Savonitto, Stefano
Kochiadakis, George
Alexopulos, Dimitrios
Uribe, Carlos E
Kanakakis, John
Faurie, Benjamin
Gabrielli, Gabriele
Gutierrez Barrios, Alejandro
Bachini, Juan Pablo
Rocha, Alex
Tam, Frankie Chor-Cheung
Rodriguez, Alfredo
Lukito, Antonia Anna
Bellemain-Appaix, Anne
Pessah, Gustavo
Cortese, Giuliana
Parodi, Guido
Burgadha, Mohammed Abed
Kedhi, Elvin
Lamelas, Pablo
Suryapranata, Harry
Nardin, Matteo
Verdoia, Monica

Grupos

Grupo de Investigación Clínica y Traslacional en Cardiología

Investigador Principal

Esther Roselló Lletí

Abstract

BACKGROUND AND AIM: Diabetes has been shown in last decades to be associated with a significantly higher mortality among patients with ST-segment elevation myocardial infarction (STEMI) treated with primary PCI (PPCI). Therefore, the aim of current study was to evaluate the impact of diabetes on times delays, reperfusion and mortality in a contemporary STEMI population undergoing PPCI, including treatment during the COVID pandemic. METHODS AND RESULTS: The ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry involving PPCI centers from Europe, Latin America, South-East Asia and North-Africa, including patients treated from 1st of March until June 30, 2019 and 2020. Primary study endpoint of this analysis was in-hospital mortality. Secondary endpoints were postprocedural TIMI 0-2 flow and 30-day mortality. Our population is represented by 16083 STEMI patients. A total of 3812 (23,7%) patients suffered from diabetes. They were older, more often males as compared to non-diabetes. Diabetic patients were less often active smokers and had less often a positive family history of CAD, but they were more often affected by hypertension and hypercholesterolemia, with higher prevalence of previous STEMI and previous CABG. Diabetic patients had longer ischemia time, had more often anterior MI, cardiogenic shock, rescue PCI and multivessel disease. They had less often out-of-hospital cardiac arrest and in-stent thrombosis, received more often a mechanical support, received less often a coronary stent and DES. Diabetes was associated with a significantly impaired postprocedural TIMI flow (TIMI 0-2: 9.8% vs 7.2%, adjusted OR [95% CI]=1.17 [1.02-1.38], p=0.024) and higher mortality (in-hospital: 9.1% vs 4.8%, Adjusted OR [95% CI]=1.70 [1.43-2.02], p<0.001; 30-day mortality: 10.8% vs 6%, Adjusted HR [95% CI]=1.46 [1.26-1.68], p<0.001) as compared to non-diabetes, particularly during the pandemic. CONCLUSIONS: Our study showed that in a contemporary STEMI population undergoing PPCI, diabetes is significantly associated with impaired epicardial reperfusion that translates into higher in-hospital and 30-day mortality, particularly during the pandemic.