In-Hospital Outcome of STEMI Patients With or Without Coronavirus Disease 2019

Abstract

Introduction: The exact mechanism of cardiac involvement remains unclear in coronavirus disease 2019 (COVID-19).ST-segment elevation myocardial infarction (STEMI) may be a first clinical manifestation of COVID-19 or there may be simultaneous presentation of STEMI & COVID-19.This study aimed to compare demographics, clinical presentation, treatment and in-hospital outcome of STEMI patients with COVID-19 or without COVID-19.

Methods: This prospective observational study was carried out at National Heart Foundation Hospital & Research Institute of Bangladesh between the periods of 08 March 2020 and 07 March 2021. All admitted STEMI patients, who become COVID-positive and without COVID-19 were included in this study. COVID-19 was confirmed with reverse transcription–polymerase chain reaction assays.

Results: A total of 1146 STEMI patients with (103) or without (1043) COVID-19 were admitted during this period. Mean age of the patients with COVID-19 was 54.87±12.77 years and without COVID-19 was 54.34±10.87 years. Male patients were predominant in both groups (85.4% vs 87.4%). History of coronary artery disease (24.3% vs 5.8%; p=0.001) and smoking (65.0% vs 51.7%; p=0.01) were prevalent in patients with COVID-19. Dyslipidemia (80.7% vs 69.9%;p=0.009) was more prevalent in patients without COVID-19. Only 22.3% (23) STEMI patients COVID-19 and 64.9% (677) STEMI patients without COVID-19 underwent coronary angiography. STEMI patients with COVID-19 had more triple vessel disease and non-significant coronary stenosis. STEMI patients with COVID-19 received more medical treatment (69.9% vs 41.2%) and less coronary intervention (10.7% vs 40.5%). Acute left ventricular failure (23.3% vs 18.4%; p=0.04) and cardiogenic shock (10.7% vs 6.7%; p=0.4) were prevalent in STEMI patients with COVID-19. Mortality rate was higher (9.7% vs 2%; p=0.03) in STEMI patients with COVID-19.

Conclusion: STEMI patients with COVID-19 represent high risk population and associated with higher morbidity and mortality than without COVID-19.