Impact of COVID-19 pandemic restrictions on ST-elevation myocardial infarction: a cardiac magnetic resonance imaging study

Abstract

Aims The severity of myocardial tissue damage following ST-elevation myocardial infarction (STEMI) strongly determines short- and long-term prognosis. This study explored the impact of the coronavirus disease 2019 (COVID-19) pandemic and associated public health restrictions on infarct severity. Methods and results STEMI patients treated with primary percutaneous coronary intervention (PCI) and included in the prospective Magnetic Resonance Imaging in Acute ST-Elevation Myocardial Infarction (MARINA-STEMI) cohort study from 2015- 2020 (n = 474) were categorized according to (i) timeframes with and without major public health restrictions in 2020, and (ii) timeframes of major public health restrictions during 2020 and during the corresponding timeframes between 2015-2019. Myocardial damage was evaluated by cardiac magnetic resonance imaging. During major public health restrictions in 2020 (n = 48), there was an increase in infarct size (22 [IQR 12-29] vs. 14 [IQR 6-23]%, P < 0.01), a higher frequency (77% vs. 52%, P < 0.01) and larger extent of microvascular obstruction (1.5 [IQR 0.1-11.4] vs. 0.2 [IQR 0.0-2.6]%, P < 0.01) and a higher rate of intramyocardial haemorrhage (56% vs. 34%, P = 0.02) as compared to the phases without major restrictions in 2020 (n = 101). These findings were confirmed in adjusted analysis and were consistent when comparing patients admitted in 2020 versus patients admitted in the “pre-pandemic” era (2015-2019). Patient characteristics were comparable between groups, except for a significantly longer total ischemia time (P < 0.01) and higher frequency of pre-PCI Thrombolysis in Myocardial Infarction (TIMI) flow 0 during times of major restrictions (P = 0.03). Conclusion This study provides novel mechanistic insights demonstrating a significant increase in myocardial damage in STEMI patients admitted during the COVID-19 pandemic with a temporal relation to major public health restrictions.

The direct and indirect effects of the COVID-19 pandemic on cardiovascular disease throughout the world

“…Among the 48 STEMI patients admitted during three separate major COVID-19 health restriction periods in 2020, there was a significant increase in myocardial infarct size (22% vs. 14%, P < 0.01), a higher frequency of microvascular obstruction (77% vs, 52%, P < 0.01), a larger extent of microvascular obstruction (1.5% vs. 0.2%, P < 0.01), and a higher rate of intramyocardial haemorrhage (56% vs. 34%, P = 0.02) as compared with 101 patients who presented during time periods without major restrictions. 14 In addition, STEMI patients who presented during COVID-19 restrictions had significantly worse CMR findings than similar patients from pre-pandemic years 2015–2019. Patient characteristics were similar between groups with or without health restrictions except that patients who presented during times of restrictions had significantly longer total ischaemic times [263 min, interquartile range (IQR) 70–531 vs. 188 min, IQR 119–381 without restrictions; P < 0.01] and a higher frequency of pre-intervention TIMI grade 0 flow (56% vs. 75%, P = 0.03).…”

“…The report by Lechner and colleagues in the current issue of the European Heart Journal provides important insights into the pathophysiological impact of the COVID-19 pandemic on patients presenting with STEMI. 14 The prospective MARINA-STEMI cohort study (NCT0110411356) conducted at the heart centre in Insbrook, Austria, enrolls patients presenting with a first STEMI who consent to undergo cardiac magnetic resonance imagimg (CMR) as part of the trial. The authors examined CMR imaging from 474 STEMI patients enrolled between 2015 and 2020.…”

Association of C-Reactive Protein Velocity with Early Left Ventricular Dysfunction in Patients with First ST-Elevation Myocardial Infarction

“…Standard software (Circle Cardiovascular Imaging, Calgary, AB, Canada) was used for post-processing analyses with the semi-automatic detection of LV endo- and epicardial borders [ 30 ]. Papillary muscles were excluded from the LV myocardial mass (LVMM) and were included in the LV volume.…”

Cardiac injury after COVID-19: Primary cardiac and primary non-cardiac etiology makes a difference

“…Another important facet of the pandemic is the associated collateral damage in the management of many other diseases. This includes all forms of heart diseases, not only the often issued delayed treatment of myocardial infarctions, has to be considered [ [3] , [4] , [5] ].…”