• Eur. J. Intern. Med. · Nov 2022

    Meta Analysis

    Angiographic and clinical outcome of SARS-CoV-2 positive patients with ST-segment elevation myocardial infarction undergoing primary angioplasty: A collaborative, individual patient data meta-analysis of six registry-based studies.

    • Giuseppe De Luca, Angelo Silverio, Monica Verdoia, Zbigniew Siudak, Tomasz Tokarek, Thomas A Kite, Anthony H Gershlick, Oriol Rodriguez-Leor, Belen Cid-Alvarez, Daniel A Jones, Krishnaraj S Rathod, José M Montero-Cabezas, Alfonso Jurado-Roman, Matteo Nardin, and Gennaro Galasso.
    • Division of Clinical and Experimental Cardiology, Azienda Ospedaliero-Universitaria Sassari, Viale S. Pietro, 43/B, Sassari 07100, Italy; Division of Clinical and Interventional Cardiology, Istituto Clinico Sant'Ambrogio, Milano, Italy. Electronic address: gdeluca@uniss.it.
    • Eur. J. Intern. Med. 2022 Nov 1; 105: 697669-76.

    BackgroundThe characteristics and outcome of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients with ST-Elevation Myocardial Infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) are still poorly known.MethodsThe PANDEMIC study was an investigator-initiated, collaborative, individual patient data (IPD) meta-analysis of registry-based studies. MEDLINE, ScienceDirect, Web of Sciences, and SCOPUS were searched to identify all registry-based studies describing the characteristics and outcome of SARS-CoV-2-positive STEMI patients undergoing PPCI. The control group consisted of SARS-CoV-2-negative STEMI patients undergoing PPCI in the same time period from the ISACS-STEMI COVID 19 registry. The primary outcome was in-hospital mortality; the secondary outcome was postprocedural reperfusion assessed by TIMI flow.ResultsOf 8 registry-based studies identified, IPD were obtained from 6 studies including 941 SARS-CoV-2-positive patients; the control group included 2005 SARS-CoV-2-negative patients. SARS-CoV-2-positive patients showed a significantly higher in-hospital mortality (p < 0.001) and worse postprocedural TIMI flow (<3, p < 0.001) compared with SARS-CoV-2-negative subjects. The increased risk for SARS-CoV-2-positive patients was significantly higher in males compared to females for both the primary (pinteraction = 0.001) and secondary outcome (pinteraction = 0.023). In SARS-CoV-2-positive patients, age ≥ 75 years (OR = 5.72; 95%CI: 1.77-18.5), impaired postprocedural TIMI flow (OR = 11.72; 95%CI: 2.64-52.10), and cardiogenic shock at presentation (OR = 11.02; 95%CI: 2.84-42.80) were independent predictors of mortality.ConclusionsIn STEMI patients undergoing PPCI, SARS-CoV-2 positivity is independently associated with impaired reperfusion and with a higher risk of in-hospital mortality, especially among male patients. Age ≥ 75 years, cardiogenic shock, and impaired postprocedural TIMI flow independently predict mortality in this high-risk population.Copyright © 2022. Published by Elsevier B.V.

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