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Impact of RAAS Inhibitors on Clinical Outcome and Mortality in Patients With STEMI During the COVID-19 Era: A Multicenter Observational Study

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 an...

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Autores principales: Barbieri, Lucia, Trabattoni, Daniela, Stefanini, Giulio G., Vizzardi, Enrico, Tumminello, Gabriele, Assanelli, Emilio, Adamo, Marianna, Pivato, Carlo A., Provenzale, Giovanni, Gentile, Domitilla, Metra, Marco, Carugo, Stefano
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8739948/
https://www.ncbi.nlm.nih.gov/pubmed/35004902
http://dx.doi.org/10.3389/fcvm.2021.792804
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author Barbieri, Lucia
Trabattoni, Daniela
Stefanini, Giulio G.
Vizzardi, Enrico
Tumminello, Gabriele
Assanelli, Emilio
Adamo, Marianna
Pivato, Carlo A.
Provenzale, Giovanni
Gentile, Domitilla
Metra, Marco
Carugo, Stefano
author_facet Barbieri, Lucia
Trabattoni, Daniela
Stefanini, Giulio G.
Vizzardi, Enrico
Tumminello, Gabriele
Assanelli, Emilio
Adamo, Marianna
Pivato, Carlo A.
Provenzale, Giovanni
Gentile, Domitilla
Metra, Marco
Carugo, Stefano
author_sort Barbieri, Lucia
collection PubMed
description 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.
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spelling pubmed-87399482022-01-08 Impact of RAAS Inhibitors on Clinical Outcome and Mortality in Patients With STEMI During the COVID-19 Era: A Multicenter Observational Study Barbieri, Lucia Trabattoni, Daniela Stefanini, Giulio G. Vizzardi, Enrico Tumminello, Gabriele Assanelli, Emilio Adamo, Marianna Pivato, Carlo A. Provenzale, Giovanni Gentile, Domitilla Metra, Marco Carugo, Stefano Front Cardiovasc Med Cardiovascular Medicine 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. Frontiers Media S.A. 2021-12-24 /pmc/articles/PMC8739948/ /pubmed/35004902 http://dx.doi.org/10.3389/fcvm.2021.792804 Text en Copyright © 2021 Barbieri, Trabattoni, Stefanini, Vizzardi, Tumminello, Assanelli, Adamo, Pivato, Provenzale, Gentile, Metra and Carugo. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Barbieri, Lucia
Trabattoni, Daniela
Stefanini, Giulio G.
Vizzardi, Enrico
Tumminello, Gabriele
Assanelli, Emilio
Adamo, Marianna
Pivato, Carlo A.
Provenzale, Giovanni
Gentile, Domitilla
Metra, Marco
Carugo, Stefano
Impact of RAAS Inhibitors on Clinical Outcome and Mortality in Patients With STEMI During the COVID-19 Era: A Multicenter Observational Study
title Impact of RAAS Inhibitors on Clinical Outcome and Mortality in Patients With STEMI During the COVID-19 Era: A Multicenter Observational Study
title_full Impact of RAAS Inhibitors on Clinical Outcome and Mortality in Patients With STEMI During the COVID-19 Era: A Multicenter Observational Study
title_fullStr Impact of RAAS Inhibitors on Clinical Outcome and Mortality in Patients With STEMI During the COVID-19 Era: A Multicenter Observational Study
title_full_unstemmed Impact of RAAS Inhibitors on Clinical Outcome and Mortality in Patients With STEMI During the COVID-19 Era: A Multicenter Observational Study
title_short Impact of RAAS Inhibitors on Clinical Outcome and Mortality in Patients With STEMI During the COVID-19 Era: A Multicenter Observational Study
title_sort impact of raas inhibitors on clinical outcome and mortality in patients with stemi during the covid-19 era: a multicenter observational study
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8739948/
https://www.ncbi.nlm.nih.gov/pubmed/35004902
http://dx.doi.org/10.3389/fcvm.2021.792804
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