Abstract 16632: Clinical Characteristics and In-Hospital Outcomes of Covid-19 Patients With Ecg St Segment Elevation: A System Wide Analysis

Abstract

Myocardial injury is seen in approximately 20% of COVID-19 patients and ST elevation myocardial infarction may be the presenting clinical manifestation. Recent data suggest that the ST-segment elevation (STE) may be due to myopericarditis. We assessed the clinical characteristics, electrocardiographic patterns, incidence, management and outcomes of COVID-19 pts with STE. Methods: We analyzed 23,406 ECGs (10,018 pts) admitted to 13 New York City area hospitals between March 1 and April 30, 2020. Results: After manual adjudication, 51 (0.5%) had focal STE, 22 (0.2%) had diffuse STE and 9,945 did not have STE. Baseline clinical characteristics were similar among the three groups, albeit a higher percentage of pts with low ejection fraction in the diffuse STE group. Cardiac catheterization was performed on 10 pts. Three pts did not have obstructive disease. Pts with focal STE were more likely to require inotropes and die during index hospitalization. Kaplan-Meier estimated overall survival rates were 31%, 33% and 6% in patients without STE, focal and diffuse STE, respectively (p < 0.0001) (Figure). By stepwise logistic regression analysis, focal STE was the strongest predictor of death (OR=7.0; CI 3.8-13.0, p<0 .0001) followed by age > 65 years (OR=3.5; CI 3.1-3.9; p<0.0001) and diffuse STE (OR=2.9; CI 1.1-7.2; p<0.0001). Female gender was associated with a decreased risk (OR 0.72; CI, 0.65-0.79; p<0.0001). Conclusions: In this large retrospective analysis of 10,018 COVID-19 pts, we observed that: 1) a very small percentage (0.7%) presented with STE; 2) 70% had focal STE and 30% had diffuse STE; 3) a minority underwent coronary angiography; 4) in-hospital mortality rates were very high for pts with STE, and even more so for those with focal STE (63% vs 46%) and; 5) focal STE was the strongest predictor of in-hospital mortality and female gender was a predictor of survival.