Abstract
BackgroundWe aimed to describe the characteristics and in-hospital outcomes of ST-segment elevation myocardial infarction (STEMI) patients during the Covid-19 era.MethodsWe conducted a prospective, multicenter study involving 13 intensive cardiac care units, to evaluate consecutive STEMI patients admitted throughout an 8-week period during the Covid-19 outbreak. These patients were compared with consecutive STEMI patients admitted during the corresponding period in 2018 who had been prospectively documented in the Israeli bi-annual National Acute Coronary Syndrome Survey. The primary end-point was defined as a composite of malignant arrhythmia, congestive heart failure, and/or in-hospital mortality. Secondary outcomes included individual components of primary outcome, cardiogenic shock, mechanical complications, electrical complications, re-infarction, stroke, and pericarditis.ResultsThe study cohort comprised 1466 consecutive acute MI patients, of whom 774 (53%) were hospitalized during the Covid-19 outbreak. Overall, 841 patients were diagnosed with STEMI: 424 (50.4%) during the Covid-19 era and 417 (49.6%) during the parallel period in 2018. Although STEMI patients admitted during the Covid-19 period had fewer co-morbidities, they presented with a higher Killip class (p value = .03). The median time from symptom onset to reperfusion was extended from 180 minutes (IQR 122–292) in 2018 to 290 minutes (IQR 161–1080, p < .001) in 2020. Hospitalization during the Covid-19 era was independently associated with an increased risk of the combined endpoint in the multivariable regression model (OR 1.65, 95% CI 1.03–2.68, p value = .04). Furthermore, the rate of mechanical complications was four times higher during the Covid-19 era (95% CI 1.42–14.8, p-value = .02). However, in-hospital mortality remained unchanged (OR 1.73, 95% CI 0.81–3.78, p-value = .16).ConclusionsSTEMI patients admitted during the first wave of Covid-19 outbreak, experienced longer total ischemic time, which was translated into a more severe disease status upon hospital admission, and a higher rate of in-hospital adverse events, compared with parallel period.
Highlights
Since the beginning of the novel, coronavirus (SARS-CoV2) pandemic in December 2019 a number of studies from Europe [1,2,3,4], the United States [5] and Hong-Kong [6] have reported significant reductions in acute myocardial infarction (AMI) hospitalizations and catheterization laboratory activation rates
segment elevation myocardial infarction (STEMI) patients admitted during the Covid-19 period had fewer co-morbidities, they presented with a higher Killip class (p value = .03)
STEMI patients admitted during the first wave of Covid-19 outbreak, experienced longer total ischemic time, which was translated into a more severe disease status upon hospital admission, and a higher rate of in-hospital adverse events, compared with parallel period
Summary
Since the beginning of the novel, coronavirus (SARS-CoV2) pandemic in December 2019 a number of studies from Europe [1,2,3,4], the United States [5] and Hong-Kong [6] have reported significant reductions in acute myocardial infarction (AMI) hospitalizations and catheterization laboratory activation rates. Several theories have been postulated to explain this observation, including fear of contracting the virus in the hospital, reduced air pollution, limited physical activity due to social restrictions, and increased utilization of telemedicine to prevent the deterioration of chronic conditions and the need for hospitalizations [1, 2, 4,5,6, 8] Contrary to this trend, previous studies have reported an increased incidence of AMI immediately following stressful situations such as earthquakes or terrorist attacks [9,10,11]. We aimed to describe the characteristics and in-hospital outcomes of ST-segment elevation myocardial infarction (STEMI) patients during the Covid-19 era
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