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Impact of diabetes in patients waiting for invasive cardiac procedures during COVID-19 pandemic

Cardiovascular Diabetology volume 20, Article number: 69 (2021) Cite this article

Abstract

Background

During COVID-19 pandemic, elective invasive cardiac procedures (ICP) have been frequently cancelled or postponed. Consequences may be more evident in patients with diabetes.

Objectives

The objective was to identify the peculiarities of patients with DM among those in whom ICP were cancelled or postponed due to the COVID-19 pandemic, as well as to identify subgroups in which the influence of DM has higher impact on the clinical outcome.

Methods

We included 2,158 patients in whom an elective ICP was cancelled or postponed during COVID-19 pandemic in 37 hospitals in Spain. Among them, 700 (32.4%) were diabetics. Patients with and without diabetes were compared.

Results

Patients with diabetes were older and had a higher prevalence of other cardiovascular risk factors, previous cardiovascular history and co-morbidities. Diabetics had a higher mortality (3.0% vs. 1.0%; p = 0.001) and cardiovascular mortality (1.9% vs. 0.4%; p = 0.001). Differences were especially important in patients with valvular heart disease (mortality 6.9% vs 1.7% [p < 0.001] and cardiovascular mortality 4.9% vs 0.9% [p = 0.002] in patients with and without diabetes, respectively). In the multivariable analysis, diabetes remained as an independent risk factor both for overall and cardiovascular mortality. No significant interaction was found with other clinical variables.

Conclusion

Among patients in whom an elective invasive cardiac procedure is cancelled or postponed during COVID-19 pandemic, mortality and cardiovascular mortality is higher in patients with diabetes, irrespectively on other clinical conditions. These procedures should not be cancelled in patients with diabetes.

Introduction

The ongoing COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared by the World Health Organization (WHO) in March 2020 [1]. By January 2021, almost 100 million people had suffered the disease, and nearly 2 million have died worldwide. Apart from these direct consequences, health care systems have been severely overwhelmed, negatively impacting on the management of other patients that usually require prompt treatment, especially those with cardiovascular diseases [2,3,4,5,6,7,8]. Specifically, invasive cardiac procedures (ICP) have been cancelled or postponed in many centers, and this may have fatal consequences for some patients, as we have recently shown in a multicenter study from Spain [9].

Cardiovascular diseases constitute the main cause of death in patients with diabetes mellitus (DM) [10], and among patients with cardiovascular diseases, those with DM are at an especially high risk of death [11, 12]. Because of that, waiting list in patients pending on cardiovascular procedures that have been postponed due to the pandemic may have especial impact among diabetics [9].

The objective was to identify the peculiarities of patients with DM among those in whom ICP were cancelled or postponed due to the COVID-19 pandemic, as well as to identify subgroups in which the influence of DM has higher impact on the clinical outcome.

Methods

Study population

We have previously published the outcome of patients in whom elective ICP were cancelled or postponed when the state of alarm due to the COVID-19 pandemic was declared in Spain on the 14th of March 2020. In this study, 2,158 patients were included in 37 hospitals [8].

At the time of the publication of that study, DM status was known in 2,110, whereas no information was available for 48 patients. For the present sub-study, doing additional efforts, directly contacting with the patient or obtaining documents from the referral centers, we could obtain DM status for all 2158 patients.

Data collection and follow-up

Data were entered in an electronic database (pInvestiga, Moaña, Pontevedra, Spain). Clinical variables, such as main cardiovascular disease pending on treatment, type of procedure pending to be performed, clinical situation, and cardiovascular risk factors, were collected.

Patients were followed-up until the 30th of April 2020 (45 days) [8]. Patients with DM were compared with those without DM, regarding type of pending procedure, main cardiovascular disease, functional class for heart failure and angina, and other clinical variables. The influence of DM in different patient subgroups was evaluated.

Definitions

Coronary angiography and/or PCI as the type of pending procedure included coronary angiography in patients with previously diagnosed or suspected CAD, and those with previously known CAD pending on PCI (e.g. stage procedures). Coronary angiography to rule out CAD as the underlying cause of left ventricular dysfunction was also included in this category. However, coronary angiography as part of the study of patients pending on any type of surgical intervention was included in a different category, because the main underlying condition was considered to be the disorder pending to be treated (e.g. valvular heart disease) rather than the eventual bystander of coronary artery disease. Other procedures included transcatheter aortic valve implantation (TAVI), percutaneous mitral valve repair, left atrial appendage closure, percutaneous closure of ASD, or treatment of tricuspid regurgitation.

Statistical analysis

Continuous variables are presented as mean ± standard deviation and compared using the Student t-test or appropriate non-parametric tests. Discrete variables are presented as percentages (proportions), and compared with the Chi-square test, using Fisher correction when needed. Statistical analysis was done using the SPSS statistical package (Chicago, Illinois). Associations were considered statistically significant when p < 0.05, although all p values are presented. Univariable and multivariable analysis were conducted in order to identify independent risk factors for mortality, and for secondary endpoints.

Results

Type of pending procedure

Out of the 2,158 patients, 700 (32.4%) were DM. Figure 1 shows the type of pending procedure in patients with and without DM. Coronary diagnostic and/or therapeutic intervention was the most frequent pending procedure for both groups of patients, but it was more frequent in DM than in non-DM (61.5% vs. 49.5%, respectively; p < 0.001). The second type of procedure was percutaneous valvular intervention, that accounted for 17.9% and 16.2% for DM and non-DM, respectively (p = 0.300). Other diagnostic procedure was pending in 14.2% and 25.2% of DM and non-DM patients, respectively (p < 0.001). Other therapeutic procedure was pending in 6.7% and 9.1% in patients with and without DM, respectively (p = 0.060).

Fig. 1
figure 1

Type of pending procedures in patiens with and without DM

Full size image

Comparison of patients with and without DM

Table 1 shows the differences among patients with and without DM in relation with clinical characteristics. Patients with DM were older, and had a higher prevalence of hypertension, hypercholesterolemia, chronic renal failure, peripheral artery disease, and previously diagnosed coronary artery disease including previous infarction, and previous myocardial revascularization. Left ventricular dysfunction was more frequently present in patients with DM. Functional class for heart failure (NYHA) was similar for patients with and without DM, but functional class for angina (CCS) was worse in patients with DM.

Table 1 Clinical characteristics of patients with and without DM
Full size table

Among the 2,158 patients, 559 had previously documented coronary artery disease. Patients with DM had higher frequency of multi-vessel disease (72.9% vs. 56.7% in non-DM, p < 0.001). Left main disease was also more frequent in patients with DM, but differences were not statistically significant (13.9% vs. 9.8% in non-DM, p = 0.133).

Influence of DM on clinical outcomes

During the 45-day follow-up period, 36 patients died (1.7%), most of them due to cardiovascular causes (n = 19, 59.4%). Patients with DM had a higher rate of both overall mortality (3.0% vs. 1.0% in non-DM, p = 0.001) and cardiovascular mortality (1.9% vs. 0.4% in non-DM, p = 0.001), whereas differences in non-cardiovascular mortality were not statistically different (1.1% vs. 0.6% in DM and non-DM, respectively; p = 0.196).

In the multivariable analysis, DM remained as an independent risk factor both for overall and cardiovascular mortality (Fig. 2).

Fig. 2
figure 2

Independent risk factors for mortality (a) and cardiovascular mortality (b)

Full size image

The proportion of patients that underwent an urgent procedure due to clinical instabilization was also significantly higher in patients with DM (10.4% vs. 7.3% in non-DM; p = 0.015).

During the study period, 17 patients with DM (2.4%) and 21 without DM (1.4%) had a diagnosis of COVID-19 by protein-chain reaction test for SARS-CoV-2 (p = 0.157). Out of these patients, 11 (29.7%) died. Among patients with COVID-19 disease, 16 were diabetics, and 21 non diabetics, mortality being higher in diabetics (6/16; 37.5%) than in non diabetics (5/21; 23.8%), but difference was not statistically significant (p = 0.475).

Mortality in patients with and without DM among different subgroups

Mortality and cardiovascular mortality were higher in patients with DM regardless the main cardiovascular disease, although differences were statistically significant only for those patients with valvular heart disease (Fig. 3a and b).

Fig. 3
figure 3

Mortality (a) and cardiovascular mortality (b) rates in patients with and without DM accordingly to the main cardiovascular disease

Full size image

Figure 4 shows the mortality and cardiovascular mortality rates in patients with and without DM in the most frequent types of pending procedures. Mortality and cardiovascular mortality rates were higher in patients pending on coronary diagnostic or therapeutic procedures, TAVI, and other diagnostic procedures, but differences reached statistical significance only for cardiovascular mortality in patients pending on TAVI. In patients pending on LAAC, mortality was higher in non-DM but differences were not statistically different.

Fig. 4
figure 4

Mortality (a) and cardiovascular mortality (b) in patients with and without DM accordingly to the type of pending procedure

Full size image

Tables 2 and 3 show the overall and cardiovascular mortality in patients with and without DM in different patient subgroups accordingly to clinical characteristics. No significant interaction was found between DM and other clinical variables (Table 4).

Table 2 Mortality in patients with and without DM in different patients subgroups
Full size table
Table 3 Cardiovascular mortality in patients with and without DM in different patients subgroups
Full size table
Table 4 Interaction between different variables and the effect of diabetes on mortality and cardiovascular mortality
Full size table

Discussion

Among patients in whom an elective cardiac invasive procedure was cancelled or postponed, those with DM had a significantly higher mortality, mainly due to a higher cardiovascular mortality. Overall mortality was 3 times higher and cardiovascular mortality 4.75 times higher in DM in comparison with patients without DM.

Patients with DM had a worse clinical profile, including more advanced age, and higher prevalence of additional cardiovascular risk factors, previous cardiovascular diseases, and some co-morbidities, such as renal failure. However, DM was an independent predictor both for mortality and cardiovascular mortality, indicating that DM per se is a risk factor in this special population. The main practical implication of these findings is that elective invasive cardiac procedures should be prioritized in patients with DM. That is, during COVID-19 pandemic, invasive cardiac procedures should not be postponed in patients with DM. Even, this may be applicable not only during COVID-19 pandemic in particular [7], but also in other situations in which health care system cannot adequately attend all patients pending on invasive procedures, and in waiting list management of interventional cardiology in general.

No significant interaction was found between DM and other clinical variables. This simplifies the indication of not cancelling ICP in patients with DM, because mortality and cardiovascular mortality was higher in patients with DM irrespectively on other clinical characteristics.

The worse outcome in patients with DM may have several reasons. First, DM is associated with an impaired systolic and diastolic left ventricular function in patients without significant coronary artery disease [13], and this could have a negative impact on the outcome of patients with heart failure or valvular heart disease. Second, DM patients have a procoagulant state [14] that may increase the risk of thromboembolic events in patients pending on structural interventions. Third, the response to anti-thrombotic agents is impaired in patients with DM [15], and this could have an impact on the risk of ischemic events in patients pending on coronary interventions. Fourth, coronary artery disease is more frequent and more severe in patients with DM and severe valvular disease [16], and this could have a negative prognostic impact on clinical outcome. Finally, DM predisposes to infections [18], that constitute an important cause of non-cardiovascular death in elderly cardiovascular patients [19, 20].

DM had a negative impact on mortality in all type of pending ICP. DM is associated with more severe coronary stenosis [17], and is a very well known risk factor for mortality in patients with CAD [11, 12].

Among patients with aortic stenosis, those with DM have a higher mortality rate [21]. This may be partly explained by the higher frequency of some co-morbidities (e.g. renal insufficiency) and CAD [16], but DM also might have a direct effect on prognosis of these patients. Among patients with aortic stenosis, those with DM have a more impaired myocardial function and more severe hypertrophy [22]. In patients with aortic valve sclerosis, insulin resistance is a powerful independent predictor of subclinical left ventricular dysfunction regardless of concomitant visceral obesity and left ventricular hypertrophy [23]. Additionally, DM impairs coronary microvascular function in asymptomatic patients with severe aortic and non-obstructed coronary arteries [24]. Besides these potential explanations, cardiac mortality rate was unexpectedly high in DM patients awaiting a valvular procedure during a relatively short follow-up (45 days), and this novel finding warrants further research.

Other procedures apart from coronary and valvular interventions had also higher mortality in patients with DM. DM is a risk factor for mortality in patients on atrial fibrillation [25], and thus it is not surprising that among patients pending on LAAC, mortality was higher in diabetics.

Study limitations

This study has several limitations. First, the main goal of this study was to evaluate the short-term consequences of delaying or postponing invasive cardiac procedures. Because of that, clinical follow-up was restricted to only 45 days. Second, metabolic control, treatment of diabetes and type of diabetes were not collected, and therefore the potential influence of these factors could not be evaluated. Finally, some patients underwent an emergent procedure due to clinical instabilization. As this occurred more frequently in patients with DM, the influence of DM on mortality in our population even may have been underestimated.

Conclusion

Among patients in whom an elective invasive cardiac procedure is cancelled or postponed, those with DM have an especial worse clinical outcome, with higher mortality and cardiovascular mortality rates at short-term, irrespective on other clinical conditions. Elective invasive cardiac procedures should be prioritized in patients with diabetes.

Availability of data and materials

The datasets during and/or analysed during the current study available from the corresponding author on reasonable request.

Abbreviations

ASD:

Atrial Septal Defect

CABG:

Coronary Artery Bypass Grafting

CAD:

Coronary Artery Disease

CCS:

Canadian Cardiac Society

COVID-19:

COronaVIrus Disease 2019

DM:

Diabetes

ICP:

Invasive Cardiac Procedures

LAAC:

Left Atrial Appendage Closure

NYHA:

New York Heart Association

PCI:

Percutaneous Coronary Intervention

SARS-CoV-2:

Severe Acute Respiratory Syndrome CoronaVirus 2

TAVI:

Transcatheter aortic valve implantation

References

  1. World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report - 78. Geneva: WHO; 2020. World Health Organization. Coronavirus disease. (COVID-19) Situation Report - 78. Geneva: WHO; 2019. p. 2020.

    Google Scholar 

  2. Rodríguez-Leor O, Cid-Álvarez B, Ojeda S, Martín-Moreiras J, Rumoroso JR, López-Palop R, et al. On behalf of all the participants of the ACI-SEC Infarction Code Registry Impact of the COVID-19 pandemic on interventional cardiology activity in Spain. Interv Cardiol. 2020;2:82–9.

    Google Scholar 

  3. Romaguera R, Cruz-González I, Jurado-Román A, Ojeda S, Fernández-Cisnal A, Jorge-Pérez P, et al. Considerations on the invasive management of ischemic and structural heart disease during the COVID-19 coronavirus outbreak. Consensus statement of the Interventional Cardiology Association and the Ischemic Heart Disease and Acute Cardiac Care Association of the Spanish Society of Cardiology. REC Interv Cardiol. 2020;2:106–11.

    Google Scholar 

  4. Rodríguez-Leor O, Cid-Álvarez B, de Prado A, Rossello X, Ojeda S, Serrador A, López-Palop R, Martín-Moreiras J, et al. Impact of COVID-19 on ST-segment elevation myocardial infarction care The Spanish experience. Rev Esp Cardiol. 2020;73:994–1002.

    Article  Google Scholar 

  5. Chieffo A, Stefanini GG, Price S, Barbato E, Tarantini G, Karam N, Moreno R, Buchanan GL, Gilard M, Halvorsen S, Huber K, James S, Neumann FJ, Möllmann H, Roffi M, Tavazzi G, Mauri Ferré J, Windecker S, Dudek D, Baumbach A. EAPCI Position Statement on Invasive Management of Acute Coronary Syndromes during the COVID-19 pandemic. Eur Heart J. 2020;41:1839–51.

    Article  CAS  Google Scholar 

  6. De Luca G, Verdoia M, Cercek M, Jensen LO, Vavlukis M, Calmac L, Johnson T, Ferrer GR, Ganyukov V, Wojakowski W, et al. Impact of COVID-19 pandemic on mechanical reperfusion for patients with STEMI. J Am Coll Cardiol. 2020;76:2321–30.

    Article  Google Scholar 

  7. Chieffo A, Tarantini G, Naber CK, Barbato E, Roffi M, Stefanini GG, Buchanan GL, Buszman P, Moreno R, Zawiślak B, Cayla G, Danenberg H, Da Silveira JAB, Nef H, James SK, Mauri Ferre J, Voskuil M, Witt N, Windecker S, Baumbach A, Dudek D. Performing elective cardiac invasive procedures during the COVID-19 outbreak: a position statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2020;41:1839–51.

    Article  CAS  Google Scholar 

  8. Moreno R, Ojeda S, Romaguera R, Jimenez-Quevedo P, Cruz-González I. Transcatheter aortic valve replacement during COVID-19 pandemic Recommendations from the Association of Interventional Cardiology of the Spanish Society of Cardiology (ACI-SEC). REC: Interv Cardiol 2020;2:230–231.

  9. Moreno R, Díez JL, Diarte JA, Macaya F, et al Consequences of canceling elective invasive cardiac procedures during Covid-19 outbreak. Catheter Cardiovasc Interv. 2020.Doi: https://doi.org/10.1002/ccd.29433(Epub ahead of print).

  10. Einarson TR, Acs A, Ludwig C, Panton UH. Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007–2017. Cardiovasc Diabetol. 2018;17:83.

    Article  Google Scholar 

  11. Malmberg K, Yusuf S, Gerstein HC, Brown J, Zhao F, Hunt D, Piegas L, Calvin J, Keltai M, Budaj A. Impact of diabetes on long-term prognosis in patients with unstable angina and non-Q-wave myocardial infarction: results of the OASIS (Organization to Assess Strategies for Ischemic Syndromes) Registry. Circulation. 2000;102:1014–9.

    Article  CAS  Google Scholar 

  12. Moreno R, de Sa E, Lopez-Sendon JL, Ortega A, Fernández MJ, Fernandez-Bobadilla J, et al. Prognosis of medically stabilized unstable angina pectoris with a negative exercise test. Am J Cardiol. 1998;82:662–5.

    Article  CAS  Google Scholar 

  13. Andersson C, Gislason GH, Weeke P, Hoffmann S, Hansen PR, Torp-Pedersen C, Søgaard P. Diabetes is associated with impaired myocardial performance in patients without significant coronary artery disease. Cardiovasc Diabetol. 2010;9:3.

    Article  Google Scholar 

  14. Jax TW, Peters AJ, Plehn G, Schoebel FC. Hemostatic risk factors in patients with coronary artery disease and type 2 diabetes - a two year follow-up of 243 patients. Cardiovasc Diabetol. 2009;8:48.

    Article  Google Scholar 

  15. Angiolillo DJ, Bernardo E, Sabaté M, Jimenez-Quevedo P, Costa MA, Palazuelos J, Hernández-Antolin R, Moreno R, Escaned J, Alfonso F, Bañuelos C, Guzman LA, Bass TA, Macaya C, Fernandez-Ortiz A. Impact of platelet reactivity on cardiovascular outcomes in patients with type 2 diabetes mellitus and coronary artery disease. J Am Coll Cardiol. 2007;50:1541–7.

    Article  Google Scholar 

  16. Lappé JM, Grodin JL, Wu Y, Bott-Silverman C, Cho L. Prevalence and prediction of obstructive coronary artery disease in patients referred for valvular heart surgery. Am J Cardiol. 2015;116:280–5.

    Article  Google Scholar 

  17. Chu ZG, Yang ZG, Dong ZH, Zhu ZY, Peng LQ, Shao H, He C, Deng W, Tang SS, Chen J. Characteristics of coronary artery disease in symptomatic type 2 diabetic patients: evaluation with CT angiography. Cardiovasc Diabetol. 2010;9:74.

    Article  Google Scholar 

  18. Moutschen MP, Scheen AJ, Lefebvre PJ. Impaired immune responses in diabetes mellitus: analysis of the factors and mechanisms involved Relevance to the increased susceptibility of diabetic patients to specific infections. Diabete Metab. 1992;18:187–201.

    CAS  PubMed  Google Scholar 

  19. Moreno R, Calvo L, Salinas P, Dobarro D, Santiago JV, Sanchez A, Galeote G, Riera L, Moreno-Gomez I, Mesa J, Plaza I, Lopez-Sendon J. Causes of peri-operative mortality after transcatheter aortic valve implantation: a pooled analysis of 12 studies and 1223 patients. J Invasive Cardiol. 2011;23:180–4.

    PubMed  Google Scholar 

  20. Aschauer S, Zotter-Tufaro C, Duca F, Kammerlander A, Dalos D, Mascherbauer J, Bonderman D. Modes of death in patients with heart failure and preserved ejection fraction. Int J Cardiol. 2017;228:422–6.

    Article  Google Scholar 

  21. Lancellotti P, Magne J, Dulgheru R, Clavel MA, Donal E, Vannan MA, Chambers J, Rosenhek R, Habib G, Lloyd G, Nistri S, Garbi M, Marchetta S, Fattouch K, Coisne A, Montaigne D, Modine T, Davin L, Gach O, Radermecker M, Liu S, Gillam L, Rossi A, Galli E, Ilardi F, Tastet L, Capoulade R, Zilberszac R, Vollema EM, Delgado V, Cosyns B, Lafitte S, Bernard A, Pierard LA, Bax JJ, Pibarot P, Oury C. Outcomes of Patients With Asymptomatic Aortic Stenosis Followed Up in Heart Valve Clinics. JAMA Cardiol. 2018;3:1060–8.

    Article  Google Scholar 

  22. Pagé A, Dumesnil JG, Clavel MA, Chan KL, Teo KK, Tam JW, Mathieu P, Després JP, Pibarot P; ASTRONOMER Investigators. Metabolic syndrome is associated with more pronounced impairment of left ventricle geometry and function in patients with calcific aortic stenosis: a substudy of the ASTRONOMER (Aortic Stenosis Progression Observation Measuring Effects of Rosuvastatin). J Am Coll Cardiol. 2010;55:1867–74.

  23. Utsunomiya H, Yamamoto H, Kunita E, Hidaka T, Kihara Y. Insulin resistance and subclinical abnormalities of global and regional left ventricular function in patients with aortic valve sclerosis. Cardiovasc Diabetol. 2014;13:86.

    Article  Google Scholar 

  24. Julius BK, Spillmann M, Vassalli G, Villari B, Eberli FR, Hess OM. Angina pectoris in patients with aortic stenosis and normal coronary arteries. Mech Pathophysiol Concepts Circ. 1997;95:892–8.

    CAS  Google Scholar 

  25. Bassand JP, Virdone S, Goldhaber SZ, Camm AJ, Fitzmaurice DA, Fox KAA, Goto S, Haas S, Hacke W, Kayani G, Mantovani LG, Misselwitz F, Pieper KS, Turpie AGG, van Eickels M, Verheugt FWA, Kakkar AK. Early risks of death, stroke/systemic embolism, and major bleeding in patients with newly diagnosed atrial fibrillation. Circulation. 2019;139:787–98.

    Article  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

Funding for data collection and analysis: Association of Interventional Cardiology of the Spanish Society of Cardiology (ACI-SEC). No funding was used for interpretation of data or manuscript writing.

Author information

Authors and Affiliations

  1. University Hospital La Paz, idiPAZ, Paseo La Castellana 261, 28046, Madrid, Spain

    Raúl Moreno

  2. Hospital La Fe, Valencia, Spain

    José-Luis Díez

  3. Hospital Miguel Servet, Zaragoza, Spain

    José-Antonio Diarte

  4. Hospital Clínico San Carlos, Madrid, Spain

    Pablo Salinas

  5. Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain

    José María de la Torre Hernández

  6. Hospital German Trias I Pujol, Badalona, Spain

    Juan F. Andres-Cordón

  7. Hospital Clínico Universitario, Santiago de Compostela, Spain

    Ramiro Trillo

  8. Hospital Virgen de La Victoria, Málaga, Spain

    Juan Alonso Briales

  9. Hospital Clínico Universitario, Valladolid, Spain

    Ignacio Amat-Santos

  10. Hospital de Bellvitge, Barcelona, Spain

    Rafael Romaguera

  11. Hospital Juan Ramón Jiménez, Huelva, Spain

    José-Francisco Díaz

  12. Hospital del Mar, Barcelona, Spain

    Beatriz Vaquerizo

  13. Hospital Reina Sofía, Córdoba, Spain

    Soledad Ojeda

  14. Hospital Universitario de Salamanca, IBSAL, CIBER CV, Salamanca, Spain

    Ignacio Cruz-González

  15. Hospital de Cabueñes, Gijón, Spain

    Daniel Morena-Salas

  16. Complejo Hospitalario, León, Spain

    Armando Pérez de Prado

  17. Hospital Doce de Octubre, Madrid, Spain

    Fernando Sarnago

  18. Hospital San Pedro de La Rioja, Logroño, Spain

    Pilar Portero

  19. Hospital Puerta del Mar, Cádiz, Spain

    Alejandro Gutierrez-Barrios

  20. Hospital de La Princesa, Madrid, Spain

    Fernando Alfonso

  21. Corporació Sanitaria Parc Tauli, Sabadell, Spain

    Eduard Bosch

  22. Hospital Virgen de L´Arrixaca, Murcia, Spain

    Eduardo Pinar

  23. Hospital Lozano Blesa, Zaragoza, Spain

    José-Ramón Ruiz-Arroyo

  24. Hospital Clínico de Navarra, Pamplona, Spain

    Valeriano Ruiz-Quevedo

  25. Hospital Universitario, Albacete, Spain

    Jesús Jiménez-Mazuecos

  26. Hospital General Universitario, Ciudad Real, Spain

    Fernando Lozano

  27. Hospital de Galdakao, Bilbao, Spain

    José-Ramón Rumoroso

  28. Hospital Universitario, Guadalajara, Spain

    Enrique Novo

  29. Policlínica de Guipúzcoa, San Sebastian, Spain

    Francisco J. Irazusta

  30. Hospital Vall D´Hebron, Barcelona, Spain

    Bruno García del Blanco

  31. Hospital Virgen de La Salud, Toledo, Spain

    José Moreu

  32. Hospital de Valme, Sevilla, Spain

    Sara M. Ballesteros-Pradas

  33. Hospital San Juan, Alicante, Spain

    Araceli Frutos

  34. Hospital Virgen del Rocío, Sevilla, Spain

    Manuel Villa

  35. Hospital Universitario de Torrejón, Universidad Francisco Vitoria, Torrejón de Ardoz, Spain

    Eduardo Alegría-Barrero

  36. Hospital Ruber Internacional, Madrid, Spain

    Eduardo Alegría-Barrero

  37. Hospital de Torrecárdenas, Almería, Spain

    Rosa Lázaro

  38. pInvestiga, Moaña, Pontevedra, Spain

    Emilio Paredes

Authors
  1. Raúl Moreno
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  2. José-Luis Díez
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  3. José-Antonio Diarte
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  4. Pablo Salinas
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  5. José María de la Torre Hernández
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  6. Juan F. Andres-Cordón
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  10. Rafael Romaguera
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  14. Ignacio Cruz-González
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  15. Daniel Morena-Salas
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Contributions

all authors have approved the submitted versión of the manuscript, and have agreed both to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.Each author contribution is detailed below: Substantial contributions to the conception: RM, JAD, JAB, APP, FS, AGB, VRQ, FJI, BGB, MV, Design of the work: RM, JLD, RT, IAS, RR, SO, ICG, JM, SMBP,.Acquisition, analysis, and interpretation of data: RM, PS, JAC, PP, JJM, AF, EP. Drafted the work or substantively revised it: RM, JMTH, JFD, BV, DMS, FA, EB, EP, JRRA, FL, JRR, EN, EAB, RL. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Raúl Moreno.

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Since this work was done during acute phase of COVID-19 pandemic, involving aspects related with the pandemic, ethics committee aproval was not required.

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Moreno, R., Díez, JL., Diarte, JA. et al. Impact of diabetes in patients waiting for invasive cardiac procedures during COVID-19 pandemic. Cardiovasc Diabetol 20, 69 (2021). https://doi.org/10.1186/s12933-021-01261-2

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  • DOI: https://doi.org/10.1186/s12933-021-01261-2

Keywords

Cardiovascular Diabetology

ISSN: 1475-2840