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

• Authors: GIUSEPPE De Luca; NARDIN Matteo; ALGOWHARY Magdy; UGUZ Berat; OLIVEIRA Dinaldo C; GANYUKOV Vladimir; ZIMBAKOV Zan; CERCEK Miha; JENSEN Lisette Okkels; LOH Poay Huan; CALMAC Lucian; FERRER Gerard Roura; QUADROS Alexandre; MILEWSKI Marek; SCOTTO di Uccio Fortunato; CLEMENS von Birgelen; VERSACI Francesco; JURRIEN Ten Berg; CASELLA Gianni; LUNG Aaron Wong Sung; KALA Petr; GIL Jose Luis Diez; CARRILLO Xavier; DIRKSEN Maurits; BECERRA-MUNOZ Victor M; LEE Michael Kang-yin; JUZAR Dafsah Arifa; JOAQUIM Rodrigo de Moura; PALADINO Roberto; MILICIC Davor; DAVLOUROS Periklis; BAKRACESKI Nikola; ZILIO Filippo; DONAZZAN Luca; KRAAIJEVELD Adriaan; GALASSO Gennaro; LUX Arpad; MARINUCCI Lucia; GUIDUCCI Vincenzo; 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; BOCCALATTE Marco; OJEDA Francisco Bosa; ARELLANO-SERRANO Carlos; 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; KANAKAKI John; FAURIE Benjamin; GABRIELLI Gabriele; BARRIOS Alejandro Gutierrez; BACHINI Juan Pablo; ROCHA Alex; TAM Frankie Chor-Cheung; RODRIGUEZ Alfredo; LUKITO Antonia Anna; SAINT-JOY Veauthyelau; PESSAH Gustavo; TUCCILLO Andrea; CORTESE Giuliana; PARODI Guido; BOURAGHDA Mohammed Abed; KEDHI Elvin; LAMELAS Pablo; SURYAPRANATA Harry; VERDOIA Monica
• Year of publication: 2021
• Type: Article in Periodical
• Magazine / Source: DIABETES EPIDEMIOLOGY AND MANAGEMENT
• MU Faculty or unit: Faculty of Medicine
• web: https://www.sciencedirect.com/science/article/pii/S2666970621000226?via%3Dihub
• Doi: http://dx.doi.org/10.1016/j.deman.2021.100022
• Keywords: renin-angiotensin system inhibitors; diabetic patients; COVID-19
• Description: 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 pri-mary 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 infec-tion 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: NCT 04412655 (c) 2021 Published by Elsevier Masson SAS.