Acute myocardial infarction during late COVID-19 era: patient characteristics, presentation and outcomes
Catarina Amaral Marques1, André Cabrita2, Paulo Araújo3
1Department of Cardiology, Centro Hospitalar Universitário São João, Porto. catarinamarques5@hotmail.com.
Insights
Late pandemic acute myocardial infarction (AMI) patients had worse outcomes despite similar care. These patients presented with more cardiovascular disease and severe symptoms, suggesting sicker individuals sought care, while milder cases may have delayed seeking help.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic has significantly impacted healthcare delivery, including the management of acute myocardial infarction (AMI).
- The specific effects on patient characteristics, presentation, treatment, and outcomes in the late pandemic period remain unclear.
Purpose of the Study:
- To evaluate the differences in patient profiles, clinical presentation, and in-hospital outcomes for acute myocardial infarction (AMI) patients during the late COVID-19 pandemic compared to pre-pandemic times.
- To investigate potential shifts in healthcare-seeking behavior among AMI patients during the pandemic.
Main Methods:
- A prospective study comparing type-1 AMI patients admitted to a tertiary care hospital.
- Data collected from 122 patients in 2019 (pre-COVID-19 group) and 196 patients in 2021 (late-COVID-19 group).
- Information gathered through patient interviews and medical record reviews.
Main Results:
- No significant differences were observed in age, gender distribution, ST-elevation myocardial infarction (STEMI) proportion, or access to coronariography and revascularization between the groups.
- Late-pandemic patients exhibited a higher prevalence of pre-existing cardiovascular disease (CVD) (43% vs. 30%), more typical and intense chest pain, increased AMI complications (27% vs. 15%), and worse Killip class (K≥2 in 22% vs. 13%).
- Despite comparable pre-hospital and hospital care, late-pandemic AMI patients experienced worse in-hospital outcomes.
Conclusions:
- Patients experiencing acute myocardial infarction (AMI) during the late pandemic presented with a greater burden of pre-existing cardiovascular disease and more severe symptoms.
- Worse in-hospital outcomes were observed in late-pandemic AMI patients, even with similar treatment access compared to pre-pandemic periods.
- Findings suggest that during the pandemic, sicker patients with more pronounced AMI symptoms were more likely to seek medical attention, while those with less severe or typical symptoms may have delayed or avoided care.
Abstract:
COVID-19 pandemic has unquestionably influenced care of acute myocardial infarction (AMI). Still, its impact on patients (pts) characteristics, presentation, treatment, and outcomes remains not well established in late pandemic times. To address this issue, we performed a prospective study of type-1 AMI patients admitted in a tertiary care hospital. Pts were enrolled during 6-months in 2019 [n=122; pre-COVID-19 (PC) group] and in 2021 [n=196; late-COVID-19 (C) group]. Data was based on pts interview and review of medical records. Age and gender distribution, as well as ST/non-ST-elevation myocardial infarction (STEMI/NSTEMI) proportion and access to coronariography and revascularization were similar between groups. Group C patients presented more pre-existing established cardiovascular disease (CVD) (43% vs 30%; p=0.03); more frequent description of typical chest pain (94% vs 84%; p=0,002); higher levels of pain intensity, in a 0-10 scale (8±2 vs 7±2; p=0.02); higher frequencies of AMI complications (27% vs 15%; p=0.01) and worse Killip (K) class evolution (K≥2 in 22% C vs13% PC patients; p=0.05). In conclusion, late pandemic AMI patients presented worse in-hospital outcomes in our study, though pre-hospital and hospital care were comparable to pre-pandemic times. COVID patients had a higher burden of pre-existing established CVD and a more typical and intense symptom presentation. Therefore, it can be hypothesized that "sicker" patients continued to look for help when presenting AMI symptoms, while "less sick" patients and the ones with less typical and intense symptoms possibly avoided contact with health care services during late pandemic period.
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