Six-Month Outcomes for COVID-19 Negative Patients with Acute Myocardial Infarction Before Versus During the COVID-19 Pandemic

Aldujeli, Ali; Hamadeh, Anas; Tecson, Kristen M.; Krivickas, Žilvinas; Maciulevicius, Laurynas; Stiklioraitis, Simas; Šukys, Marius; Briedis, Kasparas; Aldujeili, Montazar; Briede, Kamilija; Braukylienė, Rima; Pranculis, Andrius; Unikas, Ramūnas; Žaliaduonytė, Diana; McCullough, Peter A.

doi:10.1016/j.amjcard.2021.01.043

Cited by 14 publications

(7 citation statements)

References 21 publications

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“… 71 Patients admitted for NSTEMI during the pandemic, who on average waited longer for revascularization, have been reported to have over twice as high a risk of all-cause mortality and a 20-fold increased risk of hospitalization with HF at 6 months compared with historical controls. 72 Patients surviving hospitalization for HF during the pandemic also have higher all-cause mortality at 1 year compared with patients hospitalized in 2019, correlated with fewer receiving their inpatient care on specialist cardiology wards. 73 …”

Section: Resultsmentioning

confidence: 99%

The collateral damage of COVID-19 to cardiovascular services: a meta-analysis

Nadarajah

Hurdus

et al. 2022

European Heart Journal

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Aims The effect of the COVID-19 pandemic on care and outcomes across non-COVID-19 cardiovascular (CV) diseases is unknown. A systematic review and meta-analysis was performed to quantify the effect and investigate for variation by CV disease, geographic region, country income classification and the time course of the pandemic. Methods and results From January 2019 to December 2021, Medline and Embase databases were searched for observational studies comparing a pandemic and pre-pandemic period with relation to CV disease hospitalisations, diagnostic and interventional procedures, outpatient consultations, and mortality. Observational data were synthesised by incidence rate ratios (IRR) and risk ratios (RR) for binary outcomes and weighted mean differences for continuous outcomes with 95% confidence intervals. The study was registered with PROSPERO (CRD42021265930). A total of 158 studies, covering 49 countries and 6 continents, were used for quantitative synthesis. Most studies (80%) reported information for high-income countries (HICs). Across all CV disease and geographies there were fewer hospitalisations, diagnostic and interventional procedures, and outpatient consultations during the pandemic. By meta-regression, in low-middle income countries (LMICs) compared to HICs the decline in ST-segment elevation myocardial infarction (STEMI) hospitalisations (RR 0.79, 95% confidence interval [CI] 0.66–0.94) and revascularisation (RR 0.73, 95% CI 0.62–0.87) was more severe. In LMICs, but not HICs, in-hospital mortality increased for STEMI (RR 1.22, 95% CI 1.10–1.37) and heart failure (RR 1.08, 95% CI 1.04–1.12). The magnitude of decline in hospitalisations for CV diseases did not differ between the first and second wave. Conclusions There was substantial global collateral CV damage during the COVID-19 pandemic with disparity in severity by country income classification.

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Section: Resultsmentioning

confidence: 99%

The collateral damage of COVID-19 to cardiovascular services: a meta-analysis

Nadarajah

Hurdus

et al. 2022

European Heart Journal

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“…Early in the pandemic, there were fears of patients going into the hospital due to risk of SARS-CoV-2 infection. Patients might have waited at home in pain longer during the “Early Phase” because they feared contracting the virus in the emergency room and because of lockdown uncertainty, resulting in a more severe presentation and worse outcomes 17 . Furthermore, throughout the course of the COVID-19 pandemic, treatment strategies have evolved significantly as guidelines have changed and clinical knowledge has improved.…”

Section: Discussionmentioning

confidence: 99%

Evolution of Management and Outcomes of Patients with Myocardial Injury During the COVID-19 Pandemic

Case

Abramowitz

Shea

et al. 2021

The American Journal of Cardiology

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Cardiac involvement in coronavirus disease 2019 (COVID-19) has been established. This is manifested by troponin elevation and associated with worse patient prognosis. We evaluated whether patient outcomes improved as experience accumulated during the pandemic. We analyzed COVID-19-positive patients with myocardial injury (defined as troponin elevation) who presented to the MedStar Health system (11 hospitals in Washington, DC, and Maryland) during the “Early Phase” of the pandemic (March 1 – June 30, 2020) and compared their characteristics and outcomes to the COVID-19-positive patients with the presence of troponin elevation in the “Later Phase” of the pandemic (October 1, 2020 – January 31, 2021). The cohort included 788 COVID-19-positive admitted patients for whom troponin was elevated, 167 during the “Early Phase” and 621 during the “Later Phase.” Maximum troponin-I in the “Early Phase” was 13.46±34.72 ng/mL versus 11.21±20.57 ng/mL in the “Later Phase” (p = 0.553). In-hospital mortality was significantly higher in the “Later Phase” (50.3% vs. 24.6%; p<0.001), as were incidence of intensive-care-unit admission (77.8% vs. 46.1%; p<0.001) and need for mechanical ventilation (61.7% versus 28%; p<0.001). In addition, more “Early Phase” patients underwent coronary angiography (6% vs. 2.3%; p=0.013). Finally, 3% of “Early Phase” and 0.8% of “Later Phase” patients underwent percutaneous coronary intervention (p=0.025). In conclusion, treatment outcomes have significantly improved since the beginning of the pandemic in COVID-19-positive patients with troponin elevation. This may be attributed to awareness, severity of the disease, improvements in therapies, and provider experience.

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“…Studies comparing changes in CVD outcomes in 2020 were more variable when restricted to observations among patients who were admitted to the hospital ( Table 4 ). 25 Studies of hospitalized patients with heart failure in Japan and the United States as well as of patients undergoing percutaneous coronary intervention in the United States and England showed no change in in-hospital mortality. 15 , 17 , 26 In a comprehensive study including all citizens with a diagnosis of CVD in Denmark, inpatient mortality decreased by 8%.…”

Section: Hospital Mortalitymentioning

confidence: 99%