Comparison of Coronary Artery Involvement and Mortality in STEMI Patients With and Without SARS-CoV-2 During the
Ravi A Thakker1, Ayman Elbadawi2, Khaled F Chatila3
1Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.
Insights
This study found no significant difference in coronary artery involvement between patients with ST-elevation myocardial infarction (STEMI) and SARS-CoV-2 compared to those without. However, patients with STEMI and COVID-19 experienced higher in-hospital mortality.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Cardiovascular injury is a known complication of SARS-CoV-2 infection.
- Previous studies have described baseline characteristics of STEMI patients with SARS-CoV-2.
- Limited data exists on selective coronary artery involvement in STEMI patients during the COVID-19 pandemic.
Purpose of the Study:
- To investigate the likelihood of selective coronary artery involvement in patients with ST-elevation myocardial infarction (STEMI) and SARS-CoV-2.
- To compare in-hospital mortality rates between STEMI patients with and without SARS-CoV-2.
Main Methods:
- A systematic search and meta-analysis of studies published in MEDLINE, Scopus, and Cochrane databases.
- Inclusion and exclusion criteria were applied following PRISMA guidelines.
- The primary outcomes assessed were coronary artery involvement (LM, LAD, LCX, RCA) and in-hospital mortality.
Main Results:
- The analysis included 5 observational studies with 2,266 patients.
- No statistically significant difference in coronary artery disease was found in the left main (LM), left anterior descending (LAD), left circumflex (LCX), or right coronary artery (RCA) between groups.
- LAD disease was most prevalent (49.6%) in STEMI patients with SARS-CoV-2.
- In-hospital mortality was significantly higher in the STEMI and SARS-CoV-2 group (OR 5.24).
Conclusions:
- There was no significant association between STEMI and SARS-CoV-2 with selective coronary artery involvement.
- Higher mortality in STEMI patients with SARS-CoV-2 may be linked to delayed presentation, care delays, and resource allocation issues.
- Identifying and managing comorbidities is crucial for reducing mortality in these patients.
Background:
Cardiovascular injury with SARS-CoV-2 infection is well known. Several studies have outlined baseline characteristics in patients presenting with STEMI and SARS-CoV-2. Paucity in data exists in selective coronary involvement in patients with STEMI and SARS-CoV-2 during the COVID-19 pandemic.
Methods:
A systematic search and meta-analysis of studies meeting the inclusion and exclusion criteria obtained from MEDLINE, Scopus, and Cochrane databases was performed utilizing PRISMA criteria. The main outcome was likelihood of coronary artery involvement among patients with STEMI and SARS-CoV-2 versus without SARS-CoV-2. The primary adverse outcome measured was in-hospital mortality.
Results:
The final analysis included 5 observational studies with a total of 2,266 patients. There was no statistical significance in LM (OR 1.40; 95% CI: 0.68, 2.90), LAD (OR 1.09; 95% CI 0.83, 1.43), LCX (OR 1.17; 95% CI: 0.75, 1.85), or RCA (OR 0.59; 95% CI: 0.30, 1.17) disease among the 2 groups. LAD disease was the most prevalent coronary involvement among patients with STEMI and SARS-CoV-2 (49.6%). Higher in-hospital mortality was observed in the STEMI and SARS-CoV-2 group (OR 5.24; 95% CI: 3.63, 7.56).
Conclusions:
Our analysis demonstrated no statistical significance in selective coronary involvement in patients with STEMI and SARS-CoV-2 during the COVID-19 pandemic. The higher mortality among patients with SARS-CoV-2 and STEMI has been noted in prior studies with concerns being late presentation due to fear of infection, delayed care time, and poor resource allocation. Focus should be placed on identifying and managing comorbidities to reduce mortality.
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