COVID-19, Acute Myocardial Injury, and Infarction

Armando,; Conway,; Francesca,; Rocca, Della; Giovanni, Domenico; Biondi-Zoccai,; Giuseppe,; Felice, De; Francesco,; Musto,; Carmine,; Picichè,; Marco, Marco; Martuscelli,; Eugenio,; Natale, Lorenzo; Andrea, Andrea; Versaci,

doi:10.1016/j.ccep.2021.10.004

Cited by 47 publications

(77 citation statements)

References 76 publications

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“…The COVID-19 cohort exhibited a median aCCI of 3 points vs. 1 point in the non-COVID-19 cohort. A detailed analysis highlighted an increase observed in cardiovascular pathology (congestive heart failure and myocardial infarction) and dementia in the COVID-19 cohort, with data in line with similar studies (25)(26)(27), since those conditions are associated with common exacerbations, hospitalinpatient, and ultimately poor long-term outcomes. Other pulmonary diseases, such as chronic obstructive pulmonary disease, were not related to a significant increase in 1-year mortality with similar results in both cohorts (28).…”

Section: Discussionsupporting

confidence: 74%

COVID-19 as a risk factor for long-term mortality in patients managed by the emergency medical system: A prospective, multicenter, ambulance-based cohort study

Conty

Polonio-López²,

Sanz-García³

et al. 2023

Front. Public Health

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IntroductionCOVID-19 has initially been studied in terms of an acute-phase disease, although recently more attention has been given to the long-term consequences. In this study, we examined COVID-19 as an independent risk factor for long-term mortality in patients with acute illness treated by EMS (emergency medical services) who have previously had the disease against those who have not had the disease.MethodsA prospective, multicenter, ambulance-based, ongoing study was performed with adult patients with acute disease managed by EMS and transferred with high priority to the emergency department (ED) as study subjects. The study involved six advanced life support units, 38 basic life support units, and five emergency departments from Spain. Sociodemographic inputs, baseline vital signs, pre-hospital blood tests, and comorbidities, including COVID-19, were collected. The main outcome was long-term mortality, which was classified into 1-year all-cause mortality and 1-year in- and out-of-hospital mortality. To compare both the patients with COVID-19 vs. patients without COVID-19 and to compare survival vs non-survival, two main statistical analyses were performed, namely, a longitudinal analysis (Cox regression) and a logistic regression analysis.ResultsBetween 12 March 2020 and 30 September 2021, a total of 3,107 patients were included in the study, with 2,594 patients without COVID-19 and 513 patients previously suffering from COVID-19. The mortality rate was higher in patients with COVID-19 than in patients without COVID-19 (31.8 vs. 17.9%). A logistic regression showed that patients previously diagnosed with COVID-19 presented higher rates of nursing home residency, a higher number of breaths per minute, and suffering from connective disease, dementia, and congestive heart failure. The longitudinal analysis showed that COVID-19 was a risk factor for mortality [hazard ratio 1.33 (1.10–1.61); p < 0.001].ConclusionThe COVID-19 group presented an almost double mortality rate compared with the non-COVID-19 group. The final model adjusted for confusion factors suggested that COVID-19 was a risk factor for long-term mortality.

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Section: Discussionsupporting

confidence: 74%

COVID-19 as a risk factor for long-term mortality in patients managed by the emergency medical system: A prospective, multicenter, ambulance-based cohort study

Conty

Polonio-López²,

Sanz-García³

et al. 2023

Front. Public Health

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“…The ACE2 receptor serves as a master regulator of RAS. Beyond causing direct cellular damage through viral infiltration, SARS-CoV-2 downregulates ACE2 expression following unfavorable effects, including vasoconstriction, dysfunction of the endothelium, inflammatory responses (hyper-inflammation), activation of coagulation, and ultimately increased vascular permeability [ 34 ].…”

Section: Direct Cellular Injurymentioning

confidence: 99%

Cardiac Arrhythmias in Post-COVID Syndrome: Prevalence, Pathology, Diagnosis, and Treatment

Huseynov

Akın

Duerschmied

et al. 2023

Viruses

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An increase in post-COVID patients with late sequelae of acute COVID-19 infection is emerging as an ongoing challenge for physicians and healthcare professionals. Since the beginning of the pandemic, it has rapidly become evident that the acute infection is not limited to the respiratory tract but that several organs, including the cardiovascular system, can be affected. Moreover, in a significant proportion of patients (ranging from about 10 to up to 50%) with former COVID-19, cardiopulmonary symptoms such as dyspnea, palpitations, restricted physical capacity, and cardiac arrhythmias can persist weeks and months after the acute SARS-CoV-2 infection. The spectrum of COVID-19-associated arrhythmias is rather wide, most likely due to various pathomechanisms. In this article, the prevalence of cardiac arrhythmias and underlying pathologies are reviewed, including direct myocardial injury and abnormal consequences with an impact on cardiac electric instability. The hyperinflammatory reaction of the host immune system is specifically considered. Moreover, several distinct rhythm disorders occurring in post-COVID patients are discussed with regard to their clinical management.

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“…17,18,21 Following entry of SARS-CoV-2 into the host cell, ACE2 is subsequently downregulated, resulting in increased circulation of deleterious angiotensin II, which has been shown to result in cardiac dysfunction (Figure). 17,18,[22][23][24][25][26] Given this mechanism of cell entry, great concern arose surrounding the safety of continued use of chronic renin angiotensin system inhibitors, such as angiotensinconverting enzyme inhibitors and angiotensin receptor blockers, as use of these agents has been shown to increase ACE2 expression and presumably increase opportunity for viral cell entry. 6,27,28 Meanwhile, others proposed the use of these agents as possible COVID-19 therapeutics to combat the resultant downregulation of ACE2.…”

Section: Coronaviruses and The Cardiovascular System-overviewmentioning

confidence: 99%

Interaction of COVID-19 With Common Cardiovascular Disorders

Boulos

Freeman

Henry

et al. 2023

Circulation Research

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The onset and widespread dissemination of the severe acute respiratory syndrome coronavirus-2 in late 2019 impacted the world in a way not seen since the 1918 H1N1 pandemic, colloquially known as the Spanish Flu. Much like the Spanish Flu, which was observed to disproportionately impact young adults, it became clear in the early days of the coronavirus disease 2019 (COVID-19) pandemic that certain groups appeared to be at higher risk for severe illness once infected. One such group that immediately came to the forefront and garnered international attention was patients with preexisting cardiovascular disease. Here, we examine the available literature describing the interaction of COVID-19 with a myriad of cardiovascular conditions and diseases, paying particular attention to patients diagnosed with arrythmias, heart failure, and coronary artery disease. We further discuss the association of acute COVID-19 with de novo cardiovascular disease, including myocardial infarction due to coronary thrombosis, myocarditis, and new onset arrhythmias. We will evaluate various biochemical theories to explain these findings, including possible mechanisms of direct myocardial injury caused by the severe acute respiratory syndrome coronavirus-2 virus at the cellular level. Finally, we will discuss the strategies employed by numerous groups and governing bodies within the cardiovascular disease community to address the unprecedented challenges posed to the care of our most vulnerable patients, including heart transplant recipients, end-stage heart failure patients, and patients suffering from acute coronary syndromes, during the early days and height of the COVID-19 pandemic.

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COVID-19, Acute Myocardial Injury, and Infarction

Cited by 47 publications

References 76 publications

COVID-19 as a risk factor for long-term mortality in patients managed by the emergency medical system: A prospective, multicenter, ambulance-based cohort study

COVID-19 as a risk factor for long-term mortality in patients managed by the emergency medical system: A prospective, multicenter, ambulance-based cohort study

Cardiac Arrhythmias in Post-COVID Syndrome: Prevalence, Pathology, Diagnosis, and Treatment

Interaction of COVID-19 With Common Cardiovascular Disorders

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