Key result
COVID-19 infection in patients with STEMI was associated with a significantly higher rate of in-hospital mortality (OR 5.98) compared to STEMI patients without COVID-19.
Why the study?
The study aimed to investigate differences in characteristics, management, and clinical outcomes between STEMI patients presenting with versus without COVID-19 infection.
Does concurrent COVID-19 infection worsen clinical outcomes and delay management in patients presenting with STEMI?
Meta-Analysis (n=27,742)
Yes
Does concurrent COVID-19 infection worsen clinical outcomes and delay management in patients presenting with STEMI?
Odds Ratio: 5.98 (95% CI 4.78–7.48)
Absolute Event Rate: 26.5% vs 5.7%
p-value: p=<0.0001
Concurrent COVID-19 infection in STEMI patients is associated with significant delays in reperfusion times, higher thrombus burden, and markedly worse in-hospital clinical outcomes, including a nearly 6-fold increase in mortality.
STEMI with COVID-19 linked to more thrombosis and worse outcomes; leaves open whether infection-specific strategies improve prognosis.
Objectives This study aimed to investigate the differences in the characteristics, management, and clinical outcomes of patients with and that of those without coronavirus disease 2019 (COVID-19) infection who had ST-segment elevation myocardial infarction (STEMI). Methods Databases including Web of Science, PubMed, Cochrane Library, and Embase were searched up to July 2021. Observational studies that reported on the characteristics, management, or clinical outcomes and those published as full-text articles were included. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of all included studies. Results A total of 27,742 patients from 13 studies were included in this meta-analysis. Significant delay in symptom onset to first medical contact (SO-to-FMC) time (mean difference = 23.42 min; 95% CI: 5.85–40.99 min; p = 0.009) and door-to-balloon (D2B) time (mean difference = 12.27 min; 95% CI: 5.77–18.78 min; p = 0.0002) was observed in COVID-19 patients. Compared to COVID-19 negative patients, those who are positive patients had significantly higher levels of C-reactive protein, D-dimer, and thrombus grade ( p < 0.05) and showed more frequent use of thrombus aspiration and glycoprotein IIbIIIa (Gp2b3a) inhibitor ( p < 0.05). COVID-19 positive patients also had higher rates of in-hospital mortality (OR = 5.98, 95% CI: 4.78–7.48, p < 0.0001), cardiogenic shock (OR = 2.75, 95% CI: 2.02–3.76, p < 0.0001), and stent thrombosis (OR = 5.65, 95% CI: 2.41–13.23, p < 0.0001). They were also more likely to be admitted to the intensive care unit (ICU) (OR = 4.26, 95% CI: 2.51–7.22, p < 0.0001) and had a longer length of stay (mean difference = 4.63 days; 95% CI: 2.56–6.69 days; p < 0.0001). Conclusions This study revealed that COVID-19 infection had an impact on the time of initial medical intervention for patients with STEMI after symptom onset and showed that COVID-19 patients with STEMI were more likely to have thrombosis and had poorer outcomes.
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Wang et al. (2022) conducted a meta-analysis in ST-segment elevation myocardial infarction (STEMI) (n=27,742). COVID-19 infection vs. Non-COVID-19 infection was evaluated on In-hospital mortality (OR 5.98, 95% CI 4.78-7.48, p=<0.0001). COVID-19 infection in patients with STEMI was associated with a significantly higher rate of in-hospital mortality (OR 5.98) compared to STEMI patients without COVID-19.
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