No-reflow, acute heart failure and ventricular fibrillation are more common in STEMI patients in wartime conditions

Abstract

Abstract Stress and logistical problems during the wartime can change the course of STEMI and contribute to the development of in-hospital complications. The aim of our work was to analyze in-hospital complications in STEMI pts admitted during the first months of full-scale invasion of Ukraine and compare them with patients hospitalized during the same period of 2019 (pre COVID-19 era). The total number of STEMI patients hospitalized in 2022 was half as much as in 2019 (49 vs. 98 patients), which can be partly explained by civilian migration and mobilization. The average age of patients (61.0±10.7 in 2019 vs 63.5±11.7 in 2022, p=0.197) and the number of women (20.4% vs 26.5%, p=0.420) did not change. There were no significant differences in other main clinical characteristics between groups. The GRACE score in groups was almost the same (154.3±33.0 pts vs 160.8±43.5 pts, p=0.366) and about 50% of pts had anterior MI. Acute heart failure (Killip 2-3) at admission was diagnosed in 27.4% and 20.4%, cardiogenic shock (Killip 4) in 9.4% and 8.2% in 2019 and 2022, accordingly. Despite the absence of a significant difference in the level of arterial pressure, heart rate at admission was 10 bpm more during the wartime (84,0±15,4 bpm vs 74,9±20,6 bpm, p=0.005). 11.3% of STEMI pts in 2019 and 24.5% of pts in 2022 (p=0.064) were admitted after the first 24 hrs from symptoms onset. The mean time to hospitalization in pts admitted during the first 24 hrs was 4.4±3.8 hrs in 2019 and 6.4±5.6 hrs in 2022 (p=0.044). This time delay led to a lower number of pPCI made during the wartime (82.5% vs. 59.2%, p=0.005), despite the same total number of coronary angiographies (90.7% in 2019 vs. 91.5% in 2022, p=0.821) and total PCI numbers (86.6% in 2019 vs. 79.6% in 2022=0.304). No-reflow (determined as TIMI<3 or MBG<2) was registered in 34.3% of pts in 2022 and 12.9% in 2019, p=0.039. There were no differences in medical treatment between groups. DAPT was used in 97.6% and 100% (>80% ticagrelor), high intensity statins in 98.0% and 98.0%, beta-blockers in 89.5% and 90.9%, ACREI/ARB in 89.5% and 91.1%, MRA in 56.0% and 55.6% in 2019 and 2022, accordingly. In-hospital mortality in STEMI pts in wartime period was two times higher (but not significant) than in 2019 (4.9% in 2019 vs 10.2% in 2022, p=0.302). Patients with STEMI hospitalized during the first three months of the war had significantly higher rate of ventricular fibrillations (4.3% in 2019 vs 15.3% in 2022, p=0.043). Despite the lack of differences at admission acute heart failure was also significantly higher in pts treated during wartime on the 3d day of STEMI (11.2% in 2019 vs 24.5% in 2022, p=0.049). During hostilities, patients with STEMI are hospitalized later, have worse results of revascularization and a greater number of in-hospital complications.