Abstract
Conflicting results are available regarding the influence of ACEi/ARBs on the risk of COVID-19 infection, while less is known about their impact on the clinical outcome of patients with STEMI diagnosed with COVID-19. Our aim was to evaluate the impact of ACEi/ARBs therapy on in-hospital mortality and clinical outcomes of patients with STEMI during the COVID-19 pandemic. We retrospectively analyzed consecutive patients with STEMI hospitalized from February 20 to May 10, 2020 in four Hospitals in Lombardy. SARS-COV-2 diagnosis was performed by nasopharyngeal swab test. Procedural outcome, respiratory complications, and in-hospital mortality were reported. Univariate and multivariate analyses were performed by logistic regressions. Our population was represented by 182 patients with STEMI, 76.9% of which were males, and mean age was 67 ± 12.5. Hypertension was reported in 53.3%, and 29.1% was treated with ACEi/ARBs. COVID-19 diagnosis was confirmed in 17.1% of the patients. In-hospital mortality (13.2%) was significantly higher in patients with COVID-19 (31 vs. 10%, p = 0.003), even if ejection fraction [OR 0.93 (95% CI) 0.87–0.99; p = 0.03] and respiratory complications [OR 9.39 (95% CI) 1.91–45.9; p = 0.006] were the only two independent predictors. The incidence of COVID-19 infection was not influenced by ACEi/ARBs (16.5 in naïve vs. 18.8%) whose presence on admission did not correlate with respiratory complications or mortality both in the case of discontinuation and maintenance. In conclusion, in a high-risk population, such as that of patients with STEMI, the potential benefit of ACEi/ARB discontinuation in patients with COVID-19 is overcome by its detrimental effect. Intensive care, additional preventive respiratory investigations, regardless of swab test result, should be suggested for all patients admitted for STEMI during the pandemic.
Highlights
Coronavirus disease-2019 (COVID-19) is a global pandemic that has affected more than 239,000,000 patients worldwide (WHO data report, October 14th, 2021)
Hypertension was reported in 53.3% of cases treated with angiotensin converting enzyme inhibitors (ACEis) or angiotensin receptor blockers (ARBs) in 18.7 and 10.4% respectively
In the majority of cases segment-elevation myocardial infarction (STEMI) diagnosis was assessed in a pre-hospital setting (51.6%), cardiogenic shock on admission was present in 8.8%, while 7.7% of the patients experienced outof-hospital cardiac arrest
Summary
Coronavirus disease-2019 (COVID-19) is a global pandemic that has affected more than 239,000,000 patients worldwide (WHO data report, October 14th, 2021). COVID19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which penetrates cells through the angiotensinconverting enzyme 2 receptor (ACE-2) [1]. After ACE-2 was confirmed to be the SARS-CoV-2 receptor [3], it was supposed that treatment with angiotensin converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) would be harmful for COVID-19 patients. The impact of RAAS inhibitors on clinical outcome has never been investigated on patients with COVID19 presenting with ST-segment-elevation myocardial infarction (STEMI). It is well-known that all-cause mortality is reduced by 36% with an absolute reduction of 11.4% by the use of ACEi in post-infarct patients, their safety and effectiveness in patients with COVID-19 affected by acute myocardial infarction is unclear [7]. The aim of this study was to evaluate the impact of RAAS-inhibitors on in-hospital mortality and clinical outcomes of patients with STEMI patients during the pandemic
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