Impact of renin-angiotensin system inhibitors on mortality during the COVID Pandemic among STEMI patients undergoing mechanical reperfusion: Insight from an international STEMI registry.

Aged Antihypertensive Agents / therapeutic use COVID-19 / mortality Female Hospitalization Humans Male Middle Aged Myocardial Reperfusion Pandemics Percutaneous Coronary Intervention Prognosis Registries Renin-Angiotensin System SARS-CoV-2 ST Elevation Myocardial Infarction / mortality COVID-19 Drug Treatment

COVID-19 Mortality Percutaneous coronary intervention Renin-Angiotensin System inhibitors ST-segment elevation myocardial infarction

Journal

Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie

ISSN: 1950-6007

Titre abrégé: Biomed Pharmacother

Pays: France

ID NLM: 8213295

Informations de publication

Date de publication:
Jun 2021

Historique:

received: 16 11 2020

revised: 02 03 2021

accepted: 04 03 2021

pubmed: 20 3 2021

medline: 27 4 2021

entrez: 19 3 2021

Statut: ppublish

Résumé

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. 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. 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. 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.

Sections du résumé

BACKGROUND BACKGROUND

METHODS 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 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 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.

Identifiants

DOI: 10.1016/j.biopha.2021.111469 PMID: 33740523 PMC: PMC7962982

pubmed: 33740523

pii: S0753-3322(21)00254-7

doi: 10.1016/j.biopha.2021.111469

pmc: PMC7962982

pii:

doi:

Substances chimiques

Antihypertensive Agents 0

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

111469