Impact of COVID-19 on incidence and outcomes of post-infarction mechanical complications in Europe.

Adam Kowalówka,Andrea De Martino,Andrea Musazzi,Carlo Antona,Carlo De Vincentiis,Cinzia Trumello,Claudio Francesco Russo,Daniele Ronco,Dario Fina,Federica Jiritano,Federica Torchio,Giosuè Falcetta,Giovanni Troise,Giulio Massimi,Giuseppe Filiberto Serraino,Guglielmo Actis Dato,Jean-François Obadia,Jurij Matija Kalisnik,Justine Mafalda Ravaux,Marco Ranucci,Marek Deja,Mariusz Kowalewski,Massimiliano Carrozzini,Matteo Matteucci,Matteo Pozzi,Matthias Thielmann,Michele De Bonis,Michele Golino,Nikolaos Bonaros,Nikolaos Kalampokas,Paolo Severgnini,Roberto De Ponti,Roberto Lorusso,Roberto Scrofani,Shiho Naito,Stefania Blasi,Theodor Fischlein,Udo Boeken

doi:10.1093/icvts/ivad198

Abstract

Post-acute myocardial infarction mechanical complications (post-AMI MCs) represent rare but life-threatening conditions, including free-wall rupture, ventricular septal rupture and papillary muscle rupture. During the coronavirus disease-19 (COVID-19) pandemic, an overwhelming pressure on healthcare systems led to delayed and potentially suboptimal treatments for time-dependent conditions. As AMI-related hospitalizations decreased, limited information is available whether higher rates of post-AMI MCs and related deaths occurred in this setting. This study was aimed to assess how COVID-19 in Europe has impacted the incidence, treatment and outcome of MCs. The CAUTION-COVID19 study is a multicentre retrospective study collecting 175 patients with post-AMI MCs in 18 centres from 6 European countries, aimed to compare the incidence of such events, related patients' characteristics, and outcomes, between the first year of pandemic and the 2 previous years. A non-significant increase in MCs was observed [odds ratio (OR) = 1.15, 95% confidence interval (CI) 0.85-1.57; P = 0.364], with stronger growth in ventricular septal rupture diagnoses (OR = 1.43, 95% CI 0.95-2.18; P = 0.090). No significant differences in treatment types and mortality were found between the 2 periods. In-hospital mortality was 50.9% and was higher for conservatively managed cases (90.9%) and lower for surgical patients (44.0%). Patients admitted during COVID-19 more frequently had late-presenting infarction (OR = 2.47, 95% CI 1.24-4.92; P = 0.010), more stable conditions (OR = 2.61, 95% CI 1.27-5.35; P = 0.009) and higher EuroSCORE II (OR = 1.04, 95% CI 1.01-1.06; P = 0.006). A non-significant increase in MCs incidence occurred during the first year of COVID-19, characterized by a significantly higher rate of late-presenting infarction, stable conditions and EuroSCORE-II if compared to pre-pandemic data, without affecting treatment and mortality.

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