Abstract 16509: Incidence, Risk Factors and Prognostic Implications of Covid-19 St-segment Elevation Across a Large Health System in New York

Abstract

Introduction: There is limited evidence on ST elevation myocardial Infarction (STEMI) in COVID-19 patients. The aim of this study is to demonstrate the incidence of STEMI, clinical and angiographic outcomes, risk factors of COVID-19 patients among focal STEMIs, diffuse ST-elevation (STE), and no-STE. Methods: We retrospectively identified COVID-19 patients at 13 different hospitals from March 1 to April 30, 2020. All ECGs were analyzed for focal, diffuse or no-STE. Outcomes examined were death, ventilation, ICU admission, pressor and inotrope use and length of stay. Kaplan-Meier method estimated cumulative probability of death by STEMI status. Multivariate regression analysis identified association of STEMI and death. Results: There were 10,018 patients with 23,406 ECGs, of which 55 (0.5%) had focal STE, 22 (0.2%) had diffuse STE and 9,945 patients had no-STE. Death, length of stay, ICU stay, ventilator use, inotrope use, and pressor use were all statistically significant (p<0.0001) among no-STE, focal STE and diffuse STE groups. Cardiac catheterization performed on 10 STE patients, showed culprit lesions were left anterior descending artery 30%, right coronary artery 40% and no obstructive disease 30% of the time. Median symptom onset to ER presentation time in COVID STEMI was 12 hours. Figure 1 demonstrates the overall survival rates of 31%, 33%, and 6% in the no-STE, diffuse STE, and focal STE group, respectively ( P < .0001). Table 1 shows the strongest cardiac and ECG predictors of death in COVID-19 population. Conclusions: COVID-19 patients with focal STEMI and diffuse STE elevations are associated with worse survival and clinical outcomes.