Changes in characteristics and management among patients with ST-elevation myocardial infarction due to COVID-19
Batric Popovic1, Jeanne Varlot1, Pierre Adrien Metzdorf1
1Département de Cardiologie, CHU Nancy, Nancy, France.
Insights
The COVID-19 outbreak led to older ST-elevation myocardial infarction (STEMI) patients experiencing delayed treatment and increased mortality. COVID-19 patients showed higher inflammation and hypercoagulability, resulting in significantly higher in-hospital mortality.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- The coronavirus disease (COVID-19) pandemic has impacted healthcare systems globally.
- ST-elevation myocardial infarction (STEMI) is a critical cardiovascular emergency requiring timely intervention.
Purpose of the Study:
- To evaluate changes in STEMI patient characteristics and management during the COVID-19 outbreak.
- To compare STEMI patients with and without COVID-19 infection.
Main Methods:
- Prospective, monocentric study of 83 STEMI patients undergoing primary percutaneous coronary intervention (PPCI) during the COVID-19 outbreak.
- Comparison with a historical cohort (2008-2017, n=1,552) and dichotomization into non-COVID-19 (n=72) and COVID-19 (n=11) groups.
Main Results:
- STEMI patients during the outbreak were older and had delayed treatment seeking, leading to doubled in-hospital mortality compared to pre-outbreak.
- COVID-19 patients exhibited higher inflammation markers, D-dimer levels, and antiphospholipid antibodies.
- Thrombotic myocardial infarction with nonatherosclerotic coronary occlusion (MINOCA) and distal embolization were more frequent in COVID-19 patients, with significantly higher in-hospital mortality (27.3% vs 5.6%).
Conclusions:
- The COVID-19 outbreak significantly altered STEMI etiopathogenesis and management.
- Systemic inflammation and hypercoagulability in COVID-19 STEMI patients warrant further investigation for their impact on outcomes.
Objectives:
To assess changes in characteristics and management among ST-elevation myocardial infarction (STEMI) patients with coronavirus disease (COVID-19) who underwent primary percutaneous coronary intervention.
Methods:
Our prospective, monocentric study enrolled all STEMI patients who underwent PPCI during the COVID-19 outbreak (n = 83). This cohort was first compared with a previous cohort of STEMI patients (2008-2017, n = 1,552 patients) and was then dichotomized into a non-COVID-19 group (n = 72) and COVID-19 group (n = 11).
Results:
In comparison with the pre-outbreak period, patients during the outbreak period were older (59.6 ± 12.9 vs. 62.6 ± 12.2, p = .03) with a delayed seek to care (mean delay first symptoms-balloon 3.8 ± 3 vs. .7.4 ± 7.7, p < .001) resulting in a two-fold higher in-hospital mortality (non COVID-19 4.3% vs. COVID-19 8.4%, p = .07). Among the 83 STEMI patients admitted during the outbreak period, 11 patients were infected by COVID-19. Higher biological markers of inflammation (C-reactive protein: 28 ± 39 vs. 98 ± 97 mg/L, p = .04), of fibrinolysis (D-dimer: 804 ± 1,500 vs. 3,128 ± 2,458 μg/L, p = .02), and antiphospholipid antibodies in four cases were observed in the COVID-19 group. In this group, angiographic data also differed: a thrombotic myocardial infarction nonatherosclerotic coronary occlusion (MINOCA) was observed in 11 cases (1.4% vs. 54.5%, p < .001) and associated with higher post-procedure distal embolization (30.6% vs. 72.7%, p = .007). The in hospital mortality was significantly higher in the COVID-19 group (5.6% vs. 27.3%, p = .016).
Conclusion:
The COVID-19 outbreak implies deep changes in the etiopathogenesis and therapeutic management of STEMI patients with COVID-19. The impact on early and long-term outcomes of systemic inflammation and hypercoagulability in this specific population is warranted.
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