According to a study published online Oct. 29 in the Journal of the American Medical Association, a simultaneous diagnosis of COVID-19 is associated with considerably increased rates of in-hospital mortality among patients with ST-segment elevation myocardial infarction (STEMI).
Brown University’s Marwan Saad, M.D., Ph.D., and colleagues examined the characteristics, treatment, and outcomes of patients with STEMI who had COVID-19 infection vs. those who did not.
Hospital Mortality Increased By Heart Attacks And COVID-19
As per the study conducted by experts, those who had heart trouble when infected with the virus had to struggle on both sides. In most cases, they were older adults with limited immunity and hence could not struggle well.
The Vizient Clinical Database includes patients with out-of-hospital (76,434 patients) or in-hospital (4,015 patients) STEMI from 509 U.S. facilities.
The researchers discovered that COVID-19 status did not affect the likelihood of undergoing primary percutaneous coronary intervention in patients with out-of-hospital STEMI; however, patients with in-hospital STEMI and COVID-19 were significantly less likely than those without COVID-19 to undergo invasive diagnostic or therapeutic coronary procedures.
In-hospital mortality was 15.2 percent for patients with out-of-hospital STEMI with COVID-19, compared to 11.2 percent for out-of-hospital STEMI without COVID-19 (absolute difference, 4.1 percent).
In-hospital mortality was 78.5 percent for patients with in-hospital STEMI with COVID-19, compared to 46.1 percent for those with in-hospital STEMI without COVID-19 (absolute difference, 32.4 percent).
The authors of an accompanying editorial write, “The current study by Saad et al, as well as previous analyses, support current recommendations from the Society of Cardiovascular Angiography and Interventions and the American College of Cardiology demonstrating that primary PCI is feasible in patients with COVID-19 with STEMI and should remain the primary reperfusion modality in the absence of futility markers.”
The COVID-19 pandemic has had a significant impact on the management of ST-segment elevation myocardial infarction patients (STEMI).
During pandemic surges, the number of patients presenting with STEMI decreased significantly, reperfusion techniques were adjusted, and reperfusion delays were recorded worldwide.
Throughout the epidemic, poorer STEMI-related outcomes have been observed, including greater rates of in-hospital mortality. It’s unclear if these outcomes were caused by pandemic-related variables or SARS-CoV-2 infection. According to data from small cohort studies, outcomes following out-of-hospital STEMI may be worse for persons with COVID-19 than those without the virus.
The current study used a multicenter clinical database to assess patients with COVID-19 vs. those without COVID-19 who presented with out-of-hospital STEMI or developed STEMI while hospitalized to understand better the association between COVID-19 and STEMI outcome in a large, nationally representative patient cohort.
When comparing patients with and without a COVID-19 diagnosis, separate control patients from the same year and the previous year were employed to discern the direct and pandemic-related associations between COVID-19 and clinical outcome.
Patients hospitalized at each of Vizient’s 757 US academic medical institutions and affiliated hospitals in 50 states provide demographic, comorbid, clinical outcome, resource, cost, and readmission data to the Vizient Clinical Database.
In 2020, these institutes received 28 percent of their admissions from the Midwest, 24.6 percent from the Northeast, 31.2 percent from the South, and 16.1 percent from the West. Before extraction, all data were deidentified.
There were two non-overlapping study groups established. Both studies comprised individuals who were at least 18 years old. The first group (out-of-hospital group) consisted of patients who had STEMI on admission, as defined by a primary diagnosis of STEMI and a STEMI present on admission indicator (“Y”).
The second group (in-hospital group) includes patients who had a STEMI while in the hospital, as characterized by a STEMI diagnosis that was not the primary diagnosis or present at the time of admission.
