Key result
Occult SARS-CoV-2 infection in patients presenting with MI without COVID-19 symptoms did not significantly increase mortality compared to non-infected patients (14% vs 11%; p=0.564).
Why the study?
The prevalence and clinical outcomes of occult SARS-CoV-2 and influenza infections in patients presenting with myocardial infarction without COVID-19 symptoms were unknown.
Does occult SARS-CoV-2 infection worsen cardiovascular outcomes in patients presenting with acute MI without COVID-19 symptoms?
Observational (n=280)
No
Does occult SARS-CoV-2 infection worsen cardiovascular outcomes in patients presenting with acute MI without COVID-19 symptoms?
Absolute Event Rate: 14% vs 11%
p-value: p=0.564
Occult SARS-CoV-2 infection is prevalent in asymptomatic patients presenting with acute MI, though it did not significantly increase 3-month mortality in this cohort.
Supports routine SARS-CoV-2 testing in asymptomatic MI admissions; hypothesis-generating for viral precipitation of events.
OBJECTIVE: We aimed to determine the prevalence and outcome of occult infection with SARS-CoV-2 and influenza in patients presenting with myocardial infarction (MI) without COVID-19 symptoms. METHODS: We conducted an observational study from 28 June to 11 August 2020, enrolling patients admitted to the National Institute of Cardiovascular Disease Hospital, Dhaka, Bangladesh, with ST-segment elevation MI (STEMI) or non-ST-segment elevation MI who did not meet WHO criteria for suspected COVID-19. Samples were collected by nasopharyngeal swab to test for SARS-CoV-2 and influenza virus by real-time reverse transcriptase PCR. We followed up patients at 3 months (13 weeks) postadmission to record adverse cardiovascular outcomes: all-cause death, new MI, heart failure and new percutaneous coronary intervention or stent thrombosis. Survival analysis was performed using the Kaplan-Meier method. RESULTS: We enrolled 280 patients with MI, 79% male, mean age 54.5±11.8 years, 140 of whom were diagnosed with STEMI. We found 36 (13%) to be infected with SARS-CoV-2 and 1 with influenza. There was no significant difference between mortality rate observed among SARS-CoV-2 infected patients compared with non-infected (5 (14%) vs 26 (11%); p=0.564). A numerically shorter median time to a recurrent cardiovascular event was recorded among SARS-CoV-2 infected compared with non-infected patients (21 days, IQR: 8-46 vs 27 days, IQR: 7-44; p=0.378). CONCLUSION: We found a substantial rate of occult SARS-CoV-2 infection in the studied cohort, suggesting SARS-CoV-2 may precipitate MI. Asymptomatic patients with COVID-19 admitted with MI may contribute to disease transmission and warrants widespread testing of hospital admissions.
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Akhtar et al. (2021) conducted an observational in Myocardial infarction without COVID-19 symptoms (n=280). Occult SARS-CoV-2 infection vs. Non-infected patients was evaluated on All-cause death (p=0.564). Occult SARS-CoV-2 infection in patients presenting with MI without COVID-19 symptoms did not significantly increase mortality compared to non-infected patients (14% vs 11%; p=0.564).
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