Abstract 18890: Outcomes for Patients With STEMI vs NTEMI in COVID-19: A Contemporary National Insight

Abstract

Introduction: The COVID-19 pandemic posed significant challenges to cardiovascular care. Previous studies have shown that patients with NSTEMI type II have worse outcomes than those with NSTEMI type I or STEMI. In 2020, STEMI incidence was disproportionately high compared to NSTEMI. Since there are no ICD 10 codes to differentiate NSTEMI types I and II, we sought to compare patients with COVID-19 admitted for STEMI vs NSTEMI using the NIS database. Hypothesis: Given the initial pandemic response, we expect outcomes for STEMI to be worse than NSTEMI in COVID-19 patients. Methods: A retrospective analysis was completed utilizing the National Inpatient Sample (2020). Patients were identified based on ICD-10 codes corresponding to those with COVID-19 and STEMI vs. patients with COVID-19 and NSTEMI. Primary outcomes were mortality, length of stay (LOS) and total hospital charge (TOTHC). Secondary outcomes were analyzed using multivariate analysis. Results: 1,685,745 patients had COVID-19, of which 39,246 had a STEMI, and 5,818 had a NSTEMI. Average age was 62.. When comparing COVID-19, patients with STEMI vs. NSTEMI, the mortality odds ratio (OR) was 2.5 (95% CI 2.28-3.75, p < 0.001) and LOS was -1.27 days. Primary and secondary outcomes are described in Table 1. Conclusions: STEMI was significantly associated with increased mortality in the setting of COVID-19. This may explain the lower LOS and lack of difference in TOTHC between the two groups. This may be related to the initial pandemic response of strict isolation protocols with closing of catheterization and surgical suites. Patients with STEMI and COVID-19 most likely were medically managed or diagnosed late leading to increased mortality. Intubation, cardiogenic shock and cardiac arrest were all significantly associated with increased mortality, LOS and TOTHC. Future studies may show reversal of these outcomes given a return to standard operations with respect to cardiac catheterization and surgical intervention.