COVID-19 Outcomes in Patients Hospitalised with Acute Myocardial Infarction (AMI): A Protocol for Systematic Review and Meta-Analysis

Abstract

Background: Patients with cardiovascular disease and risk factors for cardiovascular illness are more likely to acquire severe 2019 novel coronavirus (2019-nCoV) infection (COVID-19). COVID-19 infection is more common in patients with cardiovascular illness, and they are more likely to develop severe symptoms. Nevertheless, whether COVID-19 patients are more likely to develop cardiovascular disorders such as acute myocardial infarction (AMI) is still up for debate. Methods: We will follow the preferred reporting items for systematic review and meta-analysis (PRISMA) to report our final study, including a systematic search of the bibliographic database using the appropriate combination of search terms or keywords. The choice of search terms is discussed in more detail later in this paper. The obtained results will be screened, and the data extracted from the studies selected for systematic review will be based on the predefined inclusion and exclusion criteria. Using the obtained data, we will then perform the associated Meta-analysis to generate the forest plot (pooled estimated effect size Hazard Ratio (HR) and 95% Confidence Intervals (CI) values) using the random-effects model. Any publication bias will be assessed using the funnel plot symmetry, Orwin and Classic Fail-Safe N Test and Begg and Mazumdar Rank Correlation Test and Egger’s Test of the intercept. In cases where insufficient data occur, we will also perform a qualitative review. Discussion: This systematic review will explore COVID-19 clinical outcomes, especially survival in patients hospitalised with Acute Myocardial Infarction, by utilising a collection of previously published data on hospitalised COVID-19 patients and Myocardial Infarction. Highlighting these prognostic survival analyses of COVID-19 patients with AMIT will have significant clinical implications by allowing for better overall treatment strategies and patient survival estimates by offering clinicians a method of quantitatively analysing the pattern of COVID-19 cardiac complications.

Role of Endomyocardial Biopsy in Diagnostics of Myocarditis

“…According to post-mortem assessment, the infection can induce myocyte ferroptosis and inflammatory infiltrates, edema in stroma and vascular walls, atrophy of cardiac muscle fibers, cardiac dilatation and focal necrosis or fibrosis, thus causing acute heart failure, reported as the second most frequent cause of mortality in SARS-CoV-2 infected patients. Although acute heart failure in some COVID-19 patients is attributable to direct cardiac injury, more frequently it occurred secondary to pulmonary overload, diffuse alveolar damage being the dominant pathological finding [ 49 , 50 , 51 ]. Initial screening for direct cardiac injury includes myocardial biomarkers, ECG and EchoCG.…”

“…In autopsy samples, cardiac involvement was considered direct on the basis of specific histological findings, including infiltration of CD68+ macrophages and CD3+, CD4+ or CD8+ lymphocytes. The inflammatory infiltrate likely developed as a response to high levels of circulatory cytokines, such as interleukin-6 and tumor necrosis factor α [ 44 , 47 , 49 ].…”

A Real Pandora’s Box in Pandemic Times: A Narrative Review on the Acute Cardiac Injury Due to COVID-19

“…This mechanism represents the basic pathophysiological substrate of ST-elevation myocardial infarction (STEMI) but also accounts for approximately 25% of cases admitted with non-ST-elevation myocardial infarction (NSTEMI) [ 42 , 43 ]. The real epidemiological impact of COVID-19 in patients with cardiac ischemia is mirrored by the worrisome incidence rates of myocardial infarction among SARS-CoV-2 positive cases, ranging from 1.1% to 8.9% [ 44 , 45 ]. The risk of developing myocardial infarction is significantly higher in the early stages of the infection, with a 5-fold increase in risk during the first 14 days of COVID-19, compared to the pre-illness period [ 46 ].…”

Disparities and Outcomes in the First and Second Year of the Pandemic on Events of Acute Myocardial Infarction in Coronavirus Disease 2019 Patients

“…Since the initial outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in late December 2019, more than 703 million people have been infected with coronavirus disease 2019 (COVID- 19), which has led to an estimated 6.9 million deaths [1,2]. The rapid impact of COVID-19 on millions of individuals prompted the World Health Organization (WHO) to declare it a pandemic in March 2020 [3]. Although the major focus is on pulmonary consequences, COVID-19 is correlated with significant direct and indirect cardiovascular implications, with the latter likely holding greater significance, specifically in time-sensitive cardiovascular emergencies [4].…”

“…Although the major focus is on pulmonary consequences, COVID-19 is correlated with significant direct and indirect cardiovascular implications, with the latter likely holding greater significance, specifically in time-sensitive cardiovascular emergencies [4]. These cardiovascular complications contribute significantly to disease mortality [3]. COVID-19 interacts with the cardiovascular system through various mechanisms, leading to complications such as myocardial injury and dysfunction in individuals with underlying cardiovascular diseases [3].…”