Background: Patients with ST-segment elevation myocardial infarction (STEMI) and COVID-19 infection have a worse clinical course and prognosis. The prognostic significance of the timing of STEMI in relation to COVID-19 infection was not investigated. Objectives: To assess whether the time of STEMI development in relation to COVID-19 infection (concurrent or following the infection) influenced the short-term prognosis. Methods: This was an observational study of consecutive COVID-19 patients with STEMI admitted to the COVID-hospital Batajnica (February 2021–March 2022). The patients were divided into the “STEMI first” group: patients with STEMI and a positive polymerase chain reaction test for COVID-19, and the “COVID-19 first” group: patients who developed STEMI during COVID-19 treatment. All patients underwent coronary angiography. The primary endpoint was in-hospital all-cause mortality. Results: The study included 87 patients with STEMI and COVID-19 (Mage, 66.7 years, 66% male). The “STEMI first” group comprised 54 (62.1%) patients, and the “COVID-19 first” group included 33 (37.9%) patients. Both groups shared a comparatively high burden of comorbidities, similar angiographic and procedural characteristics, and high percentages of performed percutaneous coronary interventions with stent implantation (90.7% vs. 87.9%). In-hospital mortality was significantly higher in the “COVID-19 first” group compared to the “STEMI first” group (51.5% vs. 27.8%). Following adjustment, the “COVID-19 first” group had a hazard ratio of 3.22 (95% confidence interval, 1.18–8.75, p = .022) for in-hospital all-cause death, compared with the “STEMI first” group (reference). Conclusion: Clinical presentation with COVID-19 infection, followed by STEMI (“COVID-19 first”), was associated with greater short-term mortality compared to patients presenting with STEMI and testing positive for COVID-19 (“STEMI first”).
De LucaGCercekMJensenLO, et al.Impact of COVID-19 pandemic and diabetes on mechanical reperfusion in patients with STEMI: insights from the ISACS STEMI COVID 19 registry. Cardiovasc Diabetol. 2020;19(1):215. doi:https://doi.org/10.1186/s12933-020-01196-0
2.
GongXZhouLDongT, et al.Impact of COVID-19 pandemic on STEMI undergoing primary PCI treatment in Beijing, China. Am J Emerg Med. 2022;53:68-72. doi:https://doi.org/10.1016/j.ajem.2021.11.034
3.
EinsteinAJShawLJHirschfeldC, et al.International impact of COVID-19 on the diagnosis of heart disease. J Am Coll Cardiol. 2021;77(2):173-185. doi:https://doi.org/10.1016/j.jacc.2020.10.054
4.
SolomonMDMcNultyEJRanaJS, et al.The COVID-19 pandemic and the incidence of acute myocardial infarction. N Engl J Med. 2020;383(7):691-693. doi:https://doi.org/10.1056/NEJMc2015630
5.
MafhamMMSpataEGoldacreR, et al.COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England. Lancet. 2020;396(10248):381-389. doi:https://doi.org/10.1016/S0140-6736(20)31356-8
6.
GarciaSAlbaghdadiMSMerajPM, et al.Reduction in ST-segment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic. J Am Coll Cardiol. 2020;75(22):2871-2872. doi:https://doi.org/10.1016/j.jacc.2020.04.011
7.
De LucaGVerdoiaMCercekM, et al.Impact of COVID-19 pandemic on mechanical reperfusion for patients with STEMI. J Am Coll Cardiol. 2020;76(20):2321-2330. doi:https://doi.org/10.1016/j.jacc.2020.09.546
8.
GarciaSDehghaniPGrinesC, et al.Initial findings from the north American COVID-19 myocardial infarction registry. J Am Coll Cardiol. 2021;77(16):1994-2003. doi:https://doi.org/10.1016/j.jacc.2021.02.055
9.
ChewNWSOwZGWTeoVXY, et al.The global effect of the COVID-19 pandemic on STEMI care: a systematic review and meta-analysis. Can J Cardiol. 2021;37(9):1450-1459. doi:https://doi.org/10.1016/j.cjca.2021.04.003
10.
ErolMKKayikciogluMKilickapM, et al.Treatment delays and in-hospital outcomes in acute myocardial infarction during the COVID-19 pandemic: a nationwide study. Anatol J Cardiol. 2020;24(5):334-342. doi:https://doi.org/10.14744/AnatolJCardiol.2020.98607
11.
BandyopadhyayDAkhtarTHajraA, et al.COVID-19 pandemic: cardiovascular complications and future implications. Am J Cardiovasc Drugs.2020;20(4):311-324. doi: https://doi.org/10.1007/s40256-020-00420-2
12.
KiteTALudmanPFGaleCP, et al.International prospective registry of acute coronary syndromes in patients with COVID-19. J Am Coll Cardiol. 2021;77(20):2466-2476. doi:https://doi.org/10.1016/j.jacc.2021.03.309
13.
Rodriguez-LeorOCid AlvarezABPerez de PradoA, et al.In-hospital outcomes of COVID-19 ST-elevation myocardial infarction patients. EuroIntervention. 2021;16(17):1426-1433. doi: https://doi.org/10.4244/EIJ-D-20-00935
14.
ThygesenKAlpertJSJaffeAS, et al.Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol. 2018;72(18):2231-2264. doi: https://doi.org/10.1016/j.jacc.2018.08.1038
15.
ChoudryFAHamshereSMRathodKS, et al.High thrombus burden in patients with COVID-19 presenting with ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2020;76(10):1168-1176. doi:https://doi.org/10.1016/j.jacc.2020.07.022
16.
SaadMKennedyKFImranH, et al.Association between COVID-19 diagnosis and in-hospital mortality in patients hospitalized with ST-segment elevation myocardial infarction. JAMA. 2021;326(19):1940-1952. doi:https://doi.org/10.1001/jama.2021.18890
17.
ClaytonTCThompsonMMeadeTW. Recent respiratory infection and risk of cardiovascular disease: case-control study through a general practice database. Eur Heart J. 2007;29(1):96-103. doi: https://doi.org/10.1093/eurheartj/ehm516
18.
KwongJCSchwartzKLCampitelliMA, et al.Acute myocardial infarction after laboratory-confirmed influenza infection. N Engl J Med. 2018;378(4):345-353. doi:https://doi.org/10.1056/NEJMoa1702090
HoFKManKKCToshnerM, et al.Thromboembolic risk in hospitalized and nonhospitalized COVID-19 patients: a self-controlled case series analysis of a nationwide cohort. Mayo Clin Proc. 2021;96(10):2587-2597. doi:https://doi.org/10.1016/j.mayocp.2021.07.002
