Key result
In-hospital RASI therapy was associated with significantly lower in-hospital mortality compared to no RASI therapy (3.3% vs 15.8%, P<0.0001) among diabetic STEMI patients.
Why the study?
Concerns arose regarding renin-angiotensin system inhibitor use during COVID-19, but data were lacking on its prognostic impact in diabetic STEMI patients undergoing mechanical reperfusion.
Does RASI therapy affect in-hospital mortality and SARS-CoV2 infection risk in diabetic patients with STEMI undergoing PPCI during the COVID-19 pandemic?
Cohort (n=3,812)
Yes
Does RASI therapy affect in-hospital mortality and SARS-CoV2 infection risk in diabetic patients with STEMI undergoing PPCI during the COVID-19 pandemic?
In diabetic patients with STEMI undergoing PPCI, RASI therapy is associated with lower in-hospital mortality and does not increase the risk of SARS-CoV2 infection.
May support RASI continuation in diabetic STEMI without raising infection risk; leaves open need for randomized confirmation.
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. 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. 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. 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. NCT 04412655
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Luca et al. (2021) conducted a cohort in Diabetic patients with STEMI (n=3,812). Renin-angiotensin system inhibitors (RASI) vs. No RASI therapy was evaluated on In-hospital mortality (p=<0.0001). In-hospital RASI therapy was associated with significantly lower in-hospital mortality compared to no RASI therapy (3.3% vs 15.8%, P<0.0001) among diabetic STEMI patients.
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