The impact of COVID-19 on hospitalization outcomes of patients with acute myocardial infarction in the USA

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute Myocardial Infarction (STEMI and NSTEMI) (n=111144). Intervention: Concomitant COVID-19 infection vs. Patients hospitalized for acute myocardial infarction without COVID-19 infection. Primary outcome: In-hospital mortality (aOR 2.72, 95% CI 2.23-3.30, p=<0.001).

Q: What does this research mean for the field?

Concomitant COVID-19 infection significantly increases in-hospital mortality, cardiorespiratory complications, and length of stay among patients hospitalized with acute myocardial infarction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the impact of coexisting COVID-19 infection on in-hospital mortality and complications among adult patients hospitalized with acute myocardial infarction in the United States.

F.E. Markson; Emmanuel Akuna; Chae Young Lim; Lakshmi Khemani; Aman Amanullah

doi:10.1016/j.ahjo.2023.100305

June 12, 2023American Heart Journal Plus Cardiology Research and PracticeOpen Access

The impact of COVID-19 on hospitalization outcomes of patients with acute myocardial infarction in the USA

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Key result

Concomitant COVID-19 infection is linked to ~2.7-fold higher in-hospital mortality during acute myocardial infarction.

aOR 2.72
95% CI 2.23-3.30
P<0.001
n=111,144

Figures

Why the study?

The COVID-19 pandemic affected health care delivery and led to variable outcomes across cardiovascular diseases, motivating an evaluation of the impact of coexisting COVID-19 infection on in-hospital outcomes in patients presenting with AMI.

Does concomitant COVID-19 infection increase in-hospital mortality and cardiorespiratory complications in adults hospitalized with acute myocardial infarction?

Key Points

To evaluate the impact of coexisting COVID-19 infection on in-hospital mortality and complications among adult patients hospitalized with acute myocardial infarction in the United States.
Retrospective observational study of adult inpatient hospitalizations (18 years and older) with a primary diagnosis of acute myocardial infarction from the 2020 National Inpatient Sample database.
Propensity score matching was conducted to balance demographic variables and comorbidities, yielding 1,154 patients with concomitant COVID-19 matched to 109,990 patients without COVID-19.
Coexisting COVID-19 infection was associated with significantly higher in-hospital mortality (16.8% vs. 6.2%; aOR: 2.72, 95% CI: 2.23–3.30, p < 0.001).
Patients with COVID-19 experienced higher rates of cardiac arrest (6.5% vs. 3.7%; aOR: 1.65, 95% CI: 1.26–2.15, p < 0.001), cardiogenic shock (13.0% vs. 8.5%; aOR: 1.36, 95% CI: 1.10–1.68, p = 0.004), and respiratory failure (24.7% vs. 16.1%; aOR: 1.81, 95% CI: 1.55–2.11, p < 0.001).
Concomitant COVID-19 was also linked to a significantly longer hospital length of stay (adjusted mean difference: 1.40, 95% CI: 1.31–1.59, p < 0.0001).

Study Design

Type

Cohort (n=111,144)

Multicenter

Yes

Structured PICO

Does concomitant COVID-19 infection increase in-hospital mortality and cardiorespiratory complications in adults hospitalized with acute myocardial infarction?

P

Population

111,144 propensity-matched adult hospitalizations with a primary diagnosis of acute myocardial infarction (1,154 with concomitant COVID-19 and 109,990 without COVID-19; total unmatched cohort N=567,990) in the United States during 2020, followed through index hospital discharge.

E

Exposure

Concomitant COVID-19 infection (identified as a secondary discharge diagnosis via ICD-10 codes)

C

Comparator

Propensity score-matched patients hospitalized with a primary diagnosis of acute myocardial infarction without concomitant COVID-19 infection

O

Outcome

In-hospital mortality during the index hospitalizationhard clinical

Main Result

Odds Ratio: 2.72 (95% CI 2.23–3.3)

Absolute Event Rate: 16.8% vs 6.2%

p-value: p=<0.001

In a large US nationwide propensity-matched cohort, concomitant COVID-19 infection in patients hospitalized with acute myocardial infarction was associated with a nearly threefold increase in in-hospital mortality as well as significantly higher rates of cardiac arrest, cardiogenic shock, and respiratory failure despite a lower baseline prevalence of traditional cardiovascular risk factors.

Limitations

Reliance on administrative dataset and ICD-10 billing codes which may be subject to coding errors
Lack of clinical data on medications, laboratory values, echocardiographic findings, and symptom severity at presentation
Potential for residual confounding despite propensity score matching
Hospitalization-level data rather than individual patient-level data, allowing potential multiple counts of readmitted individuals
Inability to determine whether COVID-19 infection was acquired before or during hospitalization
Lack of post-discharge and outpatient follow-up data
Administrative dataset relying solely on ICD-10 billing codes that may have been erroneously assigned
Database lacks information on medications, laboratory data, echocardiographic findings, and severity of symptoms at presentation
Data represent hospitalizations rather than unique individual patients, so individuals may be counted multiple times
Limited to inpatient sample without generalizability to immediate post-discharge outpatient settings
Unable to determine whether COVID-19 diagnosis was made before or during hospitalization

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Implication

Concomitant COVID-19 was associated with higher AMI mortality; extends observational data but leaves open optimal management strategies.

Abstract

The effect of the COVID-19 pandemic affected health care delivery, as it led to variable outcomes in different disease states including cardiovascular diseases. In this study, we evaluated the impact of coexisting COVID-19 on Acute Myocardial Infarction (AMI). We analyzed discharge records of AMI patients from the National Inpatient Sample (NIS) in the year 2020. Using propensity score matching, we assessed the impact of COVID-19 infection on the in-hospital outcomes of patients presenting with AMI. There were 1154 patients with concomitant COVID-19 infection and AMI who were matched with 109,990 patients with AMI and without COVID-19. We found that patients with COVID-19 who had AMI were less likely to have dyslipidemia (64.6 % vs. 70.4 %, p < 0.001), peripheral vascular disease (2.4 % vs. 3.8 % p = 0.0017), smoking history (23.5 % vs. 28.2 % p < 0.0001) and hypertension (37.1 % vs. 40.1 % p = 0.004). COVID-19 was associated with higher hospital mortality rates (Adjusted odds ratio aOR: 2.72, CI: 2.23–3.30, p < 0.001), cardiac arrest (aOR: 1.65, 95 % CI: 1.26–2.15, p < 0.001), cardiogenic shock (aOR:1.36,95 % CI: 1.10–1.68, p = 0.004) and respiratory failure (aOR:1.81, 95 % CI: 1.55–2.11 p < 0.001) compared to AMI patients without COVID-19. There was also a significant association between coexisting COVID-19 and longer duration of hospital stay (Adjusted mean differences:1.40, 95 % CI: 1.31–1.59 p < 0.0001) in AMI patients. COVID-19 infection is associated with worse in-hospital mortality and cardiorespiratory complications in patients with AMI.

Discussion

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Cite This Study

Markson et al. (2023) conducted a cohort in Acute Myocardial Infarction (STEMI and NSTEMI) (n=111,144). Concomitant COVID-19 infection vs. Patients hospitalized for acute myocardial infarction without COVID-19 infection was evaluated on In-hospital mortality (aOR 2.72, 95% CI 2.23-3.30, p=<0.001).

synapsesocial.com/papers/6a9180f249be6cf6a8467805 https://doi.org/10.1016/j.ahjo.2023.100305

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The impact of COVID-19 on hospitalization outcomes of patients with acute myocardial infarction in the USA

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

The impact of COVID-19 on hospitalization outcomes of patients with acute myocardial infarction in the USA

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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