Impact of concomitant COVID-19 on the outcome of patients with acute myocardial infarction undergoing coronary artery angiography

Abstract

BackgroundThe impact of COVID-19 on the outcome of patients with MI has not been studied widely. We aimed to evaluate the relationship between concomitant COVID-19 and the clinical course of patients admitted due to acute myocardial infarction (MI).MethodsThere was a comparison of retrospective data between patients with MI who were qualified for coronary angiography with concomitant COVID-19 and control group of patients treated for MI in the preceding year before the onset of the pandemic. In-hospital clinical data and the incidence of death from any cause on 30 days were obtained.ResultsData of 39 MI patients with concomitant COVID-19 (COVID-19 MI) and 196 MI patients without COVID-19 in pre-pandemic era (non-COVID-19 MI) were assessed. Compared with non-COVID-19 MI, COVID-19 MI was in a more severe clinical state on admission (lower systolic blood pressure: 128.51 ± 19.76 vs. 141.11 ± 32.47 mmHg, p = 0.024), higher: respiratory rate [median (interquartile range), 16 (14–18) vs. 12 (12–14)/min, p < 0.001], GRACE score (178.50 ± 46.46 vs. 161.23 ± 49.74, p = 0.041), percentage of prolonged (>24 h) time since MI symptoms onset to coronary intervention (35.9 vs. 15.3%; p = 0.004), and cardiovascular drugs were prescribed less frequently (beta-blockers: 64.1 vs. 92.8%, p = 0.009), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers: 61.5 vs. 81.1%, p < 0.001, statins: 71.8 vs. 94.4%, p < 0.001). Concomitant COVID-19 was associated with seven-fold increased risk of 30-day mortality (HR 7.117; 95% CI: 2.79–18.14; p < 0.001).ConclusionPatients admitted due to MI with COVID-19 have an increased 30-day mortality. Efforts should be focused on infection prevention and implementation of optimal management to improve the outcomes in those patients.

The impact of COVID-19 on hospitalization outcomes of patients with acute myocardial infarction in the USA

“…Similar to a single center study that showed a lower frequency of established risk factors for coronary events such as diabetes, a prior history of myocardial infarction and hypertension in patients with AMI who had co-existing COVID-19 infection [ 18 ]. This current study showed a lower frequency of smoking, hyperlipidemia, diabetes, hypertension, and peripheral vascular disease in the sub-cohort of AMI patients with COVID 19.…”

The effect of COVID-19 on the in-hospital outcomes of percutaneous coronary intervention in patients with acute coronary syndrome: A large scale meta-analysis

“…The hyperlipidemia in the COVID-19 group associated with the elevation in the thrombus incidence and the multivessel occlusion play a crucial role in limiting the full reperfusion in the coronary vessels 21 . Moreover, ACS patients with COVID-19 had a significantly higher -time from onset to PCI time- than control patients which may be due to the hospital protocol of dealing with COVID-19 patients 20 . Such delay increases the risk of further heart infarction, poor reperfusion results and mortality as well 44 .…”

“…Title and abstract screening of 1075 records based upon our inclusion and exclusion criteria resulted in 92 full texts for further screening. We included 4 papers together with another 2 papers from manual search, in addition to another 5 papers from the search update 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ( Figure 1 ).…”

Roadmap towards an institutional Impella programme for high‐risk coronary interventions

“…In Poland, the overall CVD mortality risk is high and the primary goals of secondary prevention after AMI are still not reached in 30% of patients 15 . Additionally, the COVID‐19 pandemic led to a reduction in the number of AMI patients referred for revascularization, which inevitably increased the risk profile of patients who are currently referred for percutaneous coronary intervention (PCI), with a higher prevalence of multivessel disease (MVD), left main stenosis, chronic total occlusion, last patent vessel, and concomitant severe systolic dysfunction 16,17 …”

“…15 Additionally, the COVID-19 pandemic led to a reduction in the number of AMI patients referred for revascularization, which inevitably increased the risk profile of patients who are currently referred for percutaneous coronary intervention (PCI), with a higher prevalence of multivessel disease (MVD), left main stenosis, chronic total occlusion, last patent vessel, and concomitant severe systolic dysfunction. 16,17 As a thorough understanding of the benefits and drawbacks of the Impella technology is crucial for patient outcomes, we provide a technological overview of Impella and share our experiences gathered during the implementation of institutional Impella programmes in Poland. 18 Finally, we present a roadmap of selection and periprocedural care for patients treated with Impella in the setting of HR-PCI.…”