Impact Of COVID-19 Pandemic Severity On One-year Prognosis For STEMI Patients With And Without Diabetes Mellitus

Objective(s): To explore the impact of the coronavirus disease-2019(COVID-19)pandemic severity on the long-term prognosis for ST-segment elevation myocardial infarction(STEMI)patients with and without diabetes mellitus(DM).Methods: STEMI patients who underwent primary percutaneous coronary intervention(PCI)at the 920 th Hospital of the Joint Logistic Support Force during the COVID-19 pandemic period(January,2020,to December,2021)were retrospectively included.Baseline characteristics,procedural characteristics,reperfusion time,and in-hospital clinical outcomes were collected.The one-year survival after PCI of the patients was followed up,and the endpoint event was all-cause death.STEMI patients were divided into DM and non-DM patients based on whether they were complicated with DM,and then DM and non-DM patients were further divided into low epidemic group(January 1,2020 to February 28,2021)and surge epidemic group(March 1,2021 to December 31,2021)based on the fluctuation of the monthly number of newly diagnosed COVID-19 cases in Yunnan Province.Kaplan-Meier analysis was used to draw the one-year survival curve.The multivariate Cox-proportional hazard models adjusting for covariates to analyze the relationship between the severity of the COVID-19 pandemic and one-year all-cause death.Results:1.Baseline characteristics: 723 patients with STEMI were finally included,including 156 patients(21.6%)with DM and 567 patients(78.4%)without DM.In the patients witn DM,there were 90 cases in the low epidemic group and 66 cases were in the surge epidemic group.In the patients without DM,there were 336 cases in the low epidemic group and 231 cases in the surge epidemic group.2.Procedural characteristics: In patients with DM,there were more pre-procedural TIMI flow grade 0(69.7% vs.51.1%,P = 0.020),and ventilator use(13.6% vs.3.3%,P = 0.017)in the surge epidemic group compared with the low epidemic group.In patients without DM,there was fewer pre-procedural TIMI flow grade 0(60.6% vs.68.8%,P = 0.045)in the surge epidemic group compared with the low epidemic group,but the difference in ventilator use was not statistically significant between the two groups(P > 0.05).3.Reperfusion times: In patients with DM,there were no significant differences in reperfusion times between the low epidemic and surge epidemic groups(P > 0.05).In patients without DM,there were shorter first medical contact to electrocardiogram time(4 [3,5] min vs.4 [3,6] min,P = 0.031),and door to balloon time(30 [23,40]min vs.30 [25,46] min,P = 0.049)in the surge epidemic group compared with the low epidemic group.4.In-hospital clinical outcomes: In patients with DM,there were fewer antiplatelet drugs(84.8% vs.96.7%,P = 0.008),angiotensin converting enzyme inhibitors or angiotensin receptor blockade(69.7% vs.85.6%,P = 0.017),β-blocker(68.2% vs.82.2%,P = 0.042),and lipid-lowering drugs(83.3% vs.94.4%,P = 0.024)at discharge in the surge epidemic group compared with the low epidemic group.In patients without DM,the differences in discharge medication were not statistically significant between the two groups(P > 0.05).5.Kaplan-Meier analysis: In patients with DM,there was higher one-year all-cause mortality(18.2% vs.4.4%,P = 0.005)in the surge epidemic group compared with the low epidemic group.In patients without DM,there was no statistically significant difference in one-year all-cause mortality(7.8% vs.9.5%,P =0.476)in the surge epidemic group compared with the low epidemic group.6.Multivariate Cox-proportional hazard models: After adjusting for age,male,smoking,hypertension,hypercholesterolemia,previous PCI,pre-procedural TIMI flow grade 0,post-procedural TIMI flow grade 3,thrombus aspiration,and Killip classification,the surge epidemic group still had a higher risk of one-year all-cause mortality compared with the low epidemic group in patients with DM(Hazard ratio[HR] 4.17,95% Confidence interval [CI] 1.14-15.31,P = 0.031).However,there was no difference in one-year all-cause mortality(HR 0.85,95% CI 0.46-1.56,P = 0.601)between the low epidemic and surge epidemic groups in patients without DM.Conclusion(s): The one-year risk of all-cause mortality in STEMI patients with diabetes increased with the severity of the COVID-19 pandemic,which may be related to the poor condition of the patient and insufficient secondary prevention medication.However,the severity of COVID-19 pandemic was not associated with the one-year risk of all-cause mortality in STEMI patients without diabetes.