In-hospital outcomes of COVID-19 ST-elevation myocardial infarction patients

Rodriguez-Leor, Oriol; Álvarez, Ana Belén Cid; Prado, Armando Pérez de; Rosselló, Xavier; Ojeda, Soledad; Serrador, Ana; López-Palop, Ramón; Martín‐Moreiras, Javier; Rumoroso, José Ramón; Cequier, Ángel; Ibáñez, Borja; Cruz-González, Ignatio; Romaguera, Rafael; Moreno, Raúl

doi:10.4244/eij-d-20-00935

Cited by 79 publications

(93 citation statements)

References 15 publications

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Section: Discussionsupporting

confidence: 92%

“…Our findings reinforce and extend previous reports that described an increase in in-hospital adverse events among patients presenting with STEMI during the Covid-19 pandemic [ 2 , 14 , 20 ]. While previous studies detected a higher rate of complications mainly in Covid-19 positive ACS patients, in the current report the adverse in-hospital course is unrelated to underlying infection [ 2 , 14 , 20 ]. We report a higher incidence of major in-hospital outcomes, including a 65% increase in the rate of combined primary end-point, a 2-fold increase in sustained ventricular arrhythmia and a 4-fold increase in the mechanical complications rate.…”

Section: Discussionsupporting

confidence: 92%

“…This finding is in line with the previous multicenter study from Spain that reported similar 30-day mortality rate during 2020 as compared with 2019 [ 14 ]. On the contrary, in hospital complications and mortality rate in the sub-group of Covid-19 positive ACS patients were significantly higher, compared to Covid-19 negative patients admitted during 2020, despite the comparable ischemic time [ 20 ]. In the current study we detected only one Covid-19 positive patient out of 194 (25.3%) patients tested, and therefore we could not include this in our discussion.…”

Section: Discussionmentioning

confidence: 99%

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Acute myocardial infarction in the Covid-19 era: Incidence, clinical characteristics and in-hospital outcomes—A multicenter registry

et al. 2021

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Background We aimed to describe the characteristics and in-hospital outcomes of ST-segment elevation myocardial infarction (STEMI) patients during the Covid-19 era. Methods We conducted a prospective, multicenter study involving 13 intensive cardiac care units, to evaluate consecutive STEMI patients admitted throughout an 8-week period during the Covid-19 outbreak. These patients were compared with consecutive STEMI patients admitted during the corresponding period in 2018 who had been prospectively documented in the Israeli bi-annual National Acute Coronary Syndrome Survey. The primary end-point was defined as a composite of malignant arrhythmia, congestive heart failure, and/or in-hospital mortality. Secondary outcomes included individual components of primary outcome, cardiogenic shock, mechanical complications, electrical complications, re-infarction, stroke, and pericarditis. Results The study cohort comprised 1466 consecutive acute MI patients, of whom 774 (53%) were hospitalized during the Covid-19 outbreak. Overall, 841 patients were diagnosed with STEMI: 424 (50.4%) during the Covid-19 era and 417 (49.6%) during the parallel period in 2018. Although STEMI patients admitted during the Covid-19 period had fewer co-morbidities, they presented with a higher Killip class (p value = .03). The median time from symptom onset to reperfusion was extended from 180 minutes (IQR 122–292) in 2018 to 290 minutes (IQR 161–1080, p < .001) in 2020. Hospitalization during the Covid-19 era was independently associated with an increased risk of the combined endpoint in the multivariable regression model (OR 1.65, 95% CI 1.03–2.68, p value = .04). Furthermore, the rate of mechanical complications was four times higher during the Covid-19 era (95% CI 1.42–14.8, p-value = .02). However, in-hospital mortality remained unchanged (OR 1.73, 95% CI 0.81–3.78, p-value = .16). Conclusions STEMI patients admitted during the first wave of Covid-19 outbreak, experienced longer total ischemic time, which was translated into a more severe disease status upon hospital admission, and a higher rate of in-hospital adverse events, compared with parallel period.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Acute myocardial infarction in the Covid-19 era: Incidence, clinical characteristics and in-hospital outcomes—A multicenter registry

et al. 2021

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“…Furthermore, pandemic-specific protocols require additional time to prepare medical staff and the catheterization laboratory before the procedure [1][2][3][4]. Thus, patients with STEMI might be exposed to longer delays for angiography with revascularization and increased risk of death [4,[8][9][10][11][12]. Furthermore, some data suggest additional treatment delay for PCIs performed during off-hours [13,14].…”

Section: Introductionmentioning

confidence: 99%

“…These agents might be linked with a higher rate of bleeding and vascular complications [5,6]. However, current reports emphasize hypercoagulability and high thrombus burden with potentially detrimental outcomes in patients with STEMI and COVID-19 diagnosis [8][9][10][11][12]. Irrespective of the exponential growth of evidence, there are still limited data on the clinical outcomes in STEMI with diagnosed COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Treatment Delay and Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction during the COVID-19 Pandemic

Tokarek

Dziewierz

Malinowski

et al. 2021

JCM

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Pandemic-specific protocols require additional time to prepare medical staff and catheterization laboratories. Thus, we sought to investigate treatment delay and clinical outcomes in COVID-19 positive and negative patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) during on- and off-hours. All consecutive patients with STEMI treated with PCI between 1 March and 31 December 2020 were enrolled in the analysis. A propensity score match was used to compare COVID-19 positive and negative patients for on- and off-hours. The study group was comprised of 877 paired patients treated during regular hours (every day 7:00 a.m. to 16:59 p.m.) and 418 matched pairs with PCI performed during off-hours (every day 17:00 p.m. to 06:59 a.m.) (ORPKI Polish National Registry). No difference in periprocedural mortality was observed between the two groups (on-hours: COVID-19 negative vs. COVID-19 positive: 17 (1.9%) vs. 11 (1.3%); p = 0.3; off-hours: COVID-19 negative vs. COVID-19 positive: 4 (1.0%) vs. 7 (1.7%); p = 0.5). Additionally, a similar rate of periprocedural complications was reported. Patients diagnosed with COVID-19 were exposed to longer time from first medical contact to angiography (on-hours: 133.8 (±137.1) vs. 117.1 (±135.8) (min); p = 0.001) (off-hours: 148.1 (±201.6) vs. 112.2 (±138.7) (min); p = 0.003). However, there was no influence of COVID-19 diagnosis on mortality and the prevalence of other periprocedural complications irrespective of time of intervention.

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Association Between COVID-19 Diagnosis and In-Hospital Mortality in Patients Hospitalized With ST-Segment Elevation Myocardial Infarction

Saad

Kennedy

Imran

et al. 2021

JAMA

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Key PointsQuestionIn patients with ST-segment elevation myocardial infarction (STEMI), is a concomitant diagnosis of COVID-19 associated with differences in clinical outcome?FindingsIn this retrospective cohort study that included 80 449 patients, the rates of in-hospital mortality for patients with vs without a concomitant diagnosis of COVID-19 were 15.2% vs 11.2% among those with out-of-hospital STEMI and 78.5% vs 46.1% among those with in-hospital STEMI; both differences were statistically significant.MeaningAmong patients with STEMI, a concomitant diagnosis of COVID-19 was associated with significantly higher rates of in-hospital mortality.

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In-hospital outcomes of COVID-19 ST-elevation myocardial infarction patients

Cited by 79 publications

References 15 publications

Acute myocardial infarction in the Covid-19 era: Incidence, clinical characteristics and in-hospital outcomes—A multicenter registry

Acute myocardial infarction in the Covid-19 era: Incidence, clinical characteristics and in-hospital outcomes—A multicenter registry

Treatment Delay and Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction during the COVID-19 Pandemic

Association Between COVID-19 Diagnosis and In-Hospital Mortality in Patients Hospitalized With ST-Segment Elevation Myocardial Infarction

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