Influence of Different COVID-19 Pandemic Phases on STEMI: Experience From an Italian Hub Centre
Gabriele Tumminello1, Lucia Barbieri2, Filippo Toriello2
1Cardiology Division, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy.
Insights
During the COVID-19 pandemic, ST-elevation myocardial infarction (STEMI) patients with COVID-19 experienced significantly higher in-hospital mortality, primarily due to respiratory issues. Early diagnosis is crucial for managing these high-risk patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- The Coronavirus disease 2019 (COVID-19) pandemic has impacted healthcare systems globally, with observed changes in ST-elevation acute myocardial infarction (STEMI) incidence and outcomes.
- Hospitals were reorganized, and this study analyzed STEMI patients across different pandemic phases to assess outcomes.
Discussion:
- STEMI patients who contracted COVID-19 exhibited a substantially higher in-hospital mortality rate (47.1%) compared to non-COVID-19 patients (8.6%).
- The increased mortality in COVID-19 positive STEMI patients was predominantly linked to respiratory complications, not cardiac events.
- The incidence of STEMI remained consistent across different pandemic phases, irrespective of COVID-19 prevalence in the general population.
Key Insights:
- COVID-19 infection is the strongest independent predictor of in-hospital mortality among STEMI patients.
- Respiratory complications are the main drivers of mortality in STEMI patients with COVID-19.
- The number of STEMI hospitalizations did not significantly change during the pandemic phases.
Outlook:
- Emphasizes the critical need for prompt and accurate COVID-19 diagnosis in STEMI patients.
- Highlights the necessity of tailored management strategies for high-risk STEMI patients co-infected with COVID-19.
- Suggests continued research into the complex interplay between cardiovascular events and viral infections.
Introduction:
During Coronavirus disease 2019 (COVID-19) pandemic a reduction in ST-elevation acute myocardial infarction with an increase in in-hospital mortality has been observed. In our region the pandemic temporal trend was sinusoidal with peaks and valleys. A first outbreak was in March 2020, a reduction in May 2020 and a second outbreak in November 2020.
Matherials & Methods:
Our hospital was reorganized as one of the 13 Macro-Hubs identified in Lombardy and we retrospectively analysed consecutive STEMI patients hospitalized in the three different phases of COVID-19 pandemic.
Results:
We did not register any difference in the number of STEMI hospitalized in the three phases. At multivariate analysis for the entire population COVID-19 infection was the strongest independent predictor of in-hospital mortality. Focusing on COVID-19 patients they experienced a 5-time increased incidence of in-hospital mortality (COVID-19pos vs COVID-19neg, 47.1% vs 8.6%; p < 0.0001) mainly driven by a higher incidence of respiratory complications (COVID-19pos vs COVID-19neg, 41.2% vs 6.2%; p < 0.0001) with a similar incidence of cardiac death.
Discussion:
Among STEMI admitted during different phases of pandemic, this study found an increased mortality in patients affected by COVID-19; the co-presence of COVID-19 infection leads to an increase of mortality mostly related to respiratory complications. Interestingly the different incidence in the general population of COVID-19 did not influence the incidence of STEMI.
Conclusion:
In conclusion our data suggest the crucial need for an early and precise diagnosis of COVID-19 infection in STEMI to establish a correct management of these very high-risk patients.
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