Abstract 18030: Periprocedural Outcomes of Percutaneous Coronary Interventions in Patients Admitted for Acute Myocardial Infarction and Concomitant COVID-19 Pneumonia: Insight From the National Inpatient Sample

Abstract

Background: Percutaneous coronary intervention (PCI) with drug-eluting stent (DES) placement for acute myocardial infarction (MI) is considered standard of care where a culprit lesion is identified. Coronavirus disease - 19 (COVID-19) pneumonia has been associated with a prothrombotic state, however its effects on periprocedural outcomes after PCI are unclear. We analyzed the peri-procedural outcomes in these patients who had concomitant COVID-19 pneumonia in the same hospitalization. Methods: A retrospective cohort study was conducted using the National Inpatient Sample from 2020. 300,840 hospitalizations were identified who underwent PCI and DES for acute MI. These were further stratified based on the presence of COVID-19 using ICD-10 codes. Multivariate regression analysis was used to adjust for confounders and analyze the variables. Results: Out of the 300,840 hospitalized patients who underwent PCI for acute MI, 3260 (1.1%) had COVID-19 pneumonia. In-hospital mortality was significantly higher in those with COVID-19 pneumonia (19.1% vs 3.4%; p<0.001). Mean length of stay (LOS) and mean hospital charges (HC) were higher in the presence of COVID-19 (7.83 vs 3.81 days, p<0.001 & $188,533 vs $129,570, p<0.001, respectively). Patients with COVID-19 pneumonia had higher rates of GI bleed (1.53% vs 0.07%, p=0.01), postoperative bleeds (7.0% vs 3.9%, p< 0.001), intracranial hemorrhage (ICH) (0.77% vs 0.12%, p<0.001), cardiac arrest (9.3% vs 3.7%, p<0.001) and cardiogenic shock (12.5% vs 7.3%, p<0.001). Conclusions: Patients who underwent PCI for acute MI and had COVID-19 pneumonia in the same hospitalization had significantly worse outcomes such as mortality, cardiogenic shock, cardiac arrest, postoperative bleeds, intracranial hemorrhage. While severity of COVID pneumonia likely accounts for these worse outcomes, the higher incidence of bleeding (GI, post procedure and intracranial) is concerning and needs further studies to evaluate further.