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

Giuseppe De Luca; Miha Cercek; Lisette Okkels Jensen; Oliver Bushljetikj; Lucian Calmac; Tom Johnson; Montserrat Gracida Blancas; Vladimir Ganyukov; Wojtek Wojakowski; Clemens von Birgelen; Alexander IJsselmuiden; Bernardo Tuccillo; Francesco Versaci; Jurrien Ten Berg; Mika Laine; Tim Berkout; Gianni Casella; Petr Kala; Bernabé López Ledesma; Victor Becerra; Roberto Padalino; Andrea Santucci; Xavier Carrillo; Alessandra Scoccia; Giovanni Amoroso; Arpad Lux; Tomas Kovarnik; Periklis Davlouros; Gabriele Gabrielli; Xacobe Flores Rios; Nikola Bakraceski; Sébastien Levesque; Vincenzo Guiducci; Michał Kidawa; Lucia Marinucci; Filippo Zilio; Gennaro Galasso; Enrico Fabris; Maurizio Menichelli; Stephane Manzo; Gianluca Caiazzo; Jose Moreu; Juan Sanchis Forés; Luca Donazzan; Luigi Vignali; Rui Teles; Francisco Bosa Ojeda; Heidi Lehtola; Santiago Camacho-Freiere; Adriaan Kraaijeveld; Ylitalo Antti; Gabriella Visconti; Iñigo Lozano Martínez-Luengas; Bruno Scheller; Dimitrios Alexopulos; Raul Moreno; Elvin Kedhi; Giuseppe Uccello; Benjamin Faurie; Alejandro Gutierrez Barrios; Fortunato Scotto Di Uccio; Bor Wilbert; Giuliana Cortese; Maurits T Dirksen; Guido Parodi; Monica Verdoia

doi:10.1016/j.biopha.2021.111469

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

Giuseppe De Luca, Miha Cercek, Lisette Okkels Jensen, Oliver Bushljetikj, Lucian Calmac, Tom Johnson, Montserrat Gracida Blancas, Vladimir Ganyukov, Wojtek Wojakowski, Clemens von Birgelen, Alexander IJsselmuiden, Bernardo Tuccillo, Francesco Versaci, Jurrien Ten Berg, Mika Laine, Tim Berkout, Gianni Casella, Petr Kala, Bernabé López Ledesma, Victor BecerraRoberto Padalino, Andrea Santucci, Xavier Carrillo, Alessandra Scoccia, Giovanni Amoroso, Arpad Lux, Tomas Kovarnik, Periklis Davlouros, Gabriele Gabrielli, Xacobe Flores Rios, Nikola Bakraceski, Sébastien Levesque, Vincenzo Guiducci, Michał Kidawa, Lucia Marinucci, Filippo Zilio, Gennaro Galasso, Enrico Fabris, Maurizio Menichelli, Stephane Manzo, Gianluca Caiazzo, Jose Moreu, Juan Sanchis Forés, Luca Donazzan, Luigi Vignali, Rui Teles, Francisco Bosa Ojeda, Heidi Lehtola, Santiago Camacho-Freiere, Adriaan Kraaijeveld, Ylitalo Antti, Gabriella Visconti, Iñigo Lozano Martínez-Luengas, Bruno Scheller, Dimitrios Alexopulos, Raul Moreno, Elvin Kedhi, Giuseppe Uccello, Benjamin Faurie, Alejandro Gutierrez Barrios, Fortunato Scotto Di Uccio, Bor Wilbert, Giuliana Cortese, Maurits T Dirksen, Guido Parodi, Monica Verdoia

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Abstract

Background: 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. 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: 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: 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.

Original language	English
Article number	111469
Number of pages	7
Journal	Biomedicine & pharmacotherapy = Biomédecine & pharmacothérapie
Volume	138
Early online date	16 Mar 2021
DOIs	https://doi.org/10.1016/j.biopha.2021.111469
Publication status	Published - Jun 2021

Keywords

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

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1-s2.0-S0753332221002547-mainFinal published version, 953 KBLicence: CC BY-NC-ND

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De Luca, G., Cercek, M., Okkels Jensen, L., Bushljetikj, O., Calmac, L., Johnson, T., Gracida Blancas, M., Ganyukov, V., Wojakowski, W., von Birgelen, C., IJsselmuiden, A., Tuccillo, B., Versaci, F., Ten Berg, J., Laine, M., Berkout, T., Casella, G., Kala, P., López Ledesma, B., ... Verdoia, M. (2021). Impact of renin-angiotensin system inhibitors on mortality during the COVID Pandemic among STEMI patients undergoing mechanical reperfusion: Insight from an international STEMI registry. Biomedicine & pharmacotherapy = Biomédecine & pharmacothérapie, 138, Article 111469. https://doi.org/10.1016/j.biopha.2021.111469

@article{82c461d55f6248deb84f6f34414abdf3,

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

abstract = "Background: 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. 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: 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: 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.",

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

author = "{De Luca}, Giuseppe and Miha Cercek and {Okkels Jensen}, Lisette and Oliver Bushljetikj and Lucian Calmac and Tom Johnson and {Gracida Blancas}, Montserrat and Vladimir Ganyukov and Wojtek Wojakowski and {von Birgelen}, Clemens and Alexander IJsselmuiden and Bernardo Tuccillo and Francesco Versaci and {Ten Berg}, Jurrien and Mika Laine and Tim Berkout and Gianni Casella and Petr Kala and {L{\'o}pez Ledesma}, Bernab{\'e} and Victor Becerra and Roberto Padalino and Andrea Santucci and Xavier Carrillo and Alessandra Scoccia and Giovanni Amoroso and Arpad Lux and Tomas Kovarnik and Periklis Davlouros and Gabriele Gabrielli and {Flores Rios}, Xacobe and Nikola Bakraceski and S{\'e}bastien Levesque and Vincenzo Guiducci and Micha{\l} Kidawa and Lucia Marinucci and Filippo Zilio and Gennaro Galasso and Enrico Fabris and Maurizio Menichelli and Stephane Manzo and Gianluca Caiazzo and Jose Moreu and {Sanchis For{\'e}s}, Juan and Luca Donazzan and Luigi Vignali and Rui Teles and {Bosa Ojeda}, Francisco and Heidi Lehtola and Santiago Camacho-Freiere and Adriaan Kraaijeveld and Ylitalo Antti and Gabriella Visconti and {Lozano Mart{\'i}nez-Luengas}, I{\~n}igo and Bruno Scheller and Dimitrios Alexopulos and Raul Moreno and Elvin Kedhi and Giuseppe Uccello and Benjamin Faurie and {Gutierrez Barrios}, Alejandro and {Scotto Di Uccio}, Fortunato and Bor Wilbert and Giuliana Cortese and Dirksen, {Maurits T} and Guido Parodi and Monica Verdoia",

note = "Funding Information: The study was promoted and partially funded by the Aging Project- Department of Excellence, Department of Translational Medicine, Eastern Piedmont University , Novara, Italy. Publisher Copyright: {\textcopyright} 2021 The Authors Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = jun,

doi = "10.1016/j.biopha.2021.111469",

language = "English",

volume = "138",

}

De Luca, G, Cercek, M, Okkels Jensen, L, Bushljetikj, O, Calmac, L, Johnson, T, Gracida Blancas, M, Ganyukov, V, Wojakowski, W, von Birgelen, C, IJsselmuiden, A, Tuccillo, B, Versaci, F, Ten Berg, J, Laine, M, Berkout, T, Casella, G, Kala, P, López Ledesma, B, Becerra, V, Padalino, R, Santucci, A, Carrillo, X, Scoccia, A, Amoroso, G, Lux, A, Kovarnik, T, Davlouros, P, Gabrielli, G, Flores Rios, X, Bakraceski, N, Levesque, S, Guiducci, V, Kidawa, M, Marinucci, L, Zilio, F, Galasso, G, Fabris, E, Menichelli, M, Manzo, S, Caiazzo, G, Moreu, J, Sanchis Forés, J, Donazzan, L, Vignali, L, Teles, R, Bosa Ojeda, F, Lehtola, H, Camacho-Freiere, S, Kraaijeveld, A, Antti, Y, Visconti, G, Lozano Martínez-Luengas, I, Scheller, B, Alexopulos, D, Moreno, R, Kedhi, E, Uccello, G, Faurie, B, Gutierrez Barrios, A, Scotto Di Uccio, F, Wilbert, B, Cortese, G, Dirksen, MT, Parodi, G & Verdoia, M 2021, 'Impact of renin-angiotensin system inhibitors on mortality during the COVID Pandemic among STEMI patients undergoing mechanical reperfusion: Insight from an international STEMI registry', Biomedicine & pharmacotherapy = Biomédecine & pharmacothérapie, vol. 138, 111469. https://doi.org/10.1016/j.biopha.2021.111469

Impact of renin-angiotensin system inhibitors on mortality during the COVID Pandemic among STEMI patients undergoing mechanical reperfusion: Insight from an international STEMI registry. / De Luca, Giuseppe; Cercek, Miha; Okkels Jensen, Lisette et al.
In: Biomedicine & pharmacotherapy = Biomédecine & pharmacothérapie, Vol. 138, 111469, 06.2021.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Impact of renin-angiotensin system inhibitors on mortality during the COVID Pandemic among STEMI patients undergoing mechanical reperfusion

T2 - Insight from an international STEMI registry

AU - De Luca, Giuseppe

AU - Cercek, Miha

AU - Okkels Jensen, Lisette

AU - Bushljetikj, Oliver

AU - Calmac, Lucian

AU - Johnson, Tom

AU - Gracida Blancas, Montserrat

AU - Ganyukov, Vladimir

AU - Wojakowski, Wojtek

AU - von Birgelen, Clemens

AU - IJsselmuiden, Alexander

AU - Tuccillo, Bernardo

AU - Versaci, Francesco

AU - Ten Berg, Jurrien

AU - Laine, Mika

AU - Berkout, Tim

AU - Casella, Gianni

AU - Kala, Petr

AU - López Ledesma, Bernabé

AU - Becerra, Victor

AU - Padalino, Roberto

AU - Santucci, Andrea

AU - Carrillo, Xavier

AU - Scoccia, Alessandra

AU - Amoroso, Giovanni

AU - Lux, Arpad

AU - Kovarnik, Tomas

AU - Davlouros, Periklis

AU - Gabrielli, Gabriele

AU - Flores Rios, Xacobe

AU - Bakraceski, Nikola

AU - Levesque, Sébastien

AU - Guiducci, Vincenzo

AU - Kidawa, Michał

AU - Marinucci, Lucia

AU - Zilio, Filippo

AU - Galasso, Gennaro

AU - Fabris, Enrico

AU - Menichelli, Maurizio

AU - Manzo, Stephane

AU - Caiazzo, Gianluca

AU - Moreu, Jose

AU - Sanchis Forés, Juan

AU - Donazzan, Luca

AU - Vignali, Luigi

AU - Teles, Rui

AU - Bosa Ojeda, Francisco

AU - Lehtola, Heidi

AU - Camacho-Freiere, Santiago

AU - Kraaijeveld, Adriaan

AU - Antti, Ylitalo

AU - Visconti, Gabriella

AU - Lozano Martínez-Luengas, Iñigo

AU - Scheller, Bruno

AU - Alexopulos, Dimitrios

AU - Moreno, Raul

AU - Kedhi, Elvin

AU - Uccello, Giuseppe

AU - Faurie, Benjamin

AU - Gutierrez Barrios, Alejandro

AU - Scotto Di Uccio, Fortunato

AU - Wilbert, Bor

AU - Cortese, Giuliana

AU - Dirksen, Maurits T

AU - Parodi, Guido

AU - Verdoia, Monica

N1 - Funding Information: The study was promoted and partially funded by the Aging Project- Department of Excellence, Department of Translational Medicine, Eastern Piedmont University , Novara, Italy. Publisher Copyright: © 2021 The Authors Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/6

Y1 - 2021/6

N2 - Background: 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. 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: 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: 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.

AB - Background: 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. 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: 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: 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.

KW - COVID-19

KW - Mortality

KW - Percutaneous coronary intervention

KW - Renin-Angiotensin System inhibitors

KW - ST-segment elevation myocardial infarction

UR - http://www.scopus.com/inward/record.url?scp=85102599132&partnerID=8YFLogxK

U2 - 10.1016/j.biopha.2021.111469

DO - 10.1016/j.biopha.2021.111469

M3 - Article

C2 - 33740523

SN - 0753-3322

VL - 138

JO - Biomedicine & pharmacotherapy = Biomédecine & pharmacothérapie

JF - Biomedicine & pharmacotherapy = Biomédecine & pharmacothérapie

M1 - 111469

ER -

De Luca G, Cercek M, Okkels Jensen L, Bushljetikj O, Calmac L, Johnson T et al. Impact of renin-angiotensin system inhibitors on mortality during the COVID Pandemic among STEMI patients undergoing mechanical reperfusion: Insight from an international STEMI registry. Biomedicine & pharmacotherapy = Biomédecine & pharmacothérapie. 2021 Jun;138:111469. Epub 2021 Mar 16. doi: 10.1016/j.biopha.2021.111469

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

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