Effect of COVID-19 pandemic on six-month mortality and clinical outcomes of patients with ST-elevation myocardial infarction

Abstract

Introduction:The coronavirus disease 2019 (COVID-19) infection has changed everyday clinical practice, with a shortage of solid data about its implications for ST-elevation myocardial infarction (STEMI) patients.Aim: To evaluate the impact of COVID-19 on 6-month clinical outcomes of patients with STEMI and determine the mortality predictors after STEMI during the COVID-19 pandemic.Material and methods: This prospective observational study was conducted on consecutive STEMI patients who presented to our hospital between April and October 2021. A total of 74 COVID-19-positive patients were included in group I and compared to 148 COVID-19-negative patients (group II). We compared the two cohorts' rates of major adverse cardiovascular events (MACEs; composite of death from any cause, recurrent MI, target-vessel revascularization, and stroke) at 6 months.Results: COVID-19 STEMI patients were more likely to present with angina equivalent symptoms, had higher Killip class at admission, and higher levels of high-sensitive cardiac troponin T and serum C-reactive protein. The 6-month rates of MACEs were significantly higher in STEMI patients with COVID-19 compared to non-COVID-19 patients (41.9% vs. 16.9%, respectively; p < 0.001) and were mainly due to higher in-hospital mortality (20.3% vs. 6.1%, respectively; p = 0.001). The independent predictors of 6-month mortality in STEMI patients during the COVID-19 pandemic were the absence of ST resolution, low systolic blood and higher Killip class on admission, presence of severe MR and atrial fibrillation, and anterior wall STEMI.Conclusions: STEMI patients with superimposed COVID-19 infection had worse clinical outcomes, with almost three times higher in-hospital mortality and 6-month MACEs.

Multifaceted Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on ST-Elevation Myocardial Infarction (STEMI): A Literature Review of Incidence, Treatment Modalities, and Outcomes

“…A noteworthy trend in mortality rates among STEMI patients during the pandemic has been observed. A study has shown that there has been a threefold increase in in-hospital mortality for STEMI patients with COVID-19 [16]. Besides, during the pandemic, STEMI patients have been found to have a higher need for circulatory support, worse thrombolysis in myocardial infarction (TIMI) flow, and a significantly higher 30-day mortality rate [1].…”

“…However, COVID-19 patients with STEMI tend to have a higher burden of coronary thrombus compared to non-COVID-19 patients [ 15 ]. Analysis of STEMI outcomes during the pandemic reveals significant challenges, including a threefold increase in in-hospital mortality for STEMI patients with COVID-19 and delays in receiving proper treatment [ 16 ]. Complications such as stent thrombosis and cardiogenic shock are more common, especially among older patients, who also face longer procedure times and higher mortality rates [ 17 ].…”

Differences in door-to-balloon time and outcomes in SARS-CoV-2-positive ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: A systematic review and meta-analysis

“…Previous researchers have investigated that ST-segment elevation myocardial infarction (STEMI) patients with COVID-19-positive have a high in-hospital mortality. [ 11 , 12 ] However, the effect of this finding was finite because of the limited statistical power, and we could not calculate indirect and direct causes of enhancement mortality in COVID-19-positive patients.…”