Key result
SARS-CoV-2 positivity in STEMI patients undergoing mechanical reperfusion was associated with significantly higher in-hospital mortality compared to negative patients (25.7% vs 7.0%, adjusted OR 3.2).
Why the study?
SARS-CoV-2 was suggested to promote thrombotic complications and higher mortality, but its impact on STEMI patients undergoing primary PCI was unclear.
Does SARS-CoV-2 positivity increase in-hospital and 30-day mortality in STEMI patients undergoing primary PCI?
Cohort (n=2,114)
Yes
Does SARS-CoV-2 positivity increase in-hospital and 30-day mortality in STEMI patients undergoing primary PCI?
Odds Ratio: 3.2 (95% CI 1.71–5.99)
Absolute Event Rate: 25.7% vs 7%
p-value: p=<0.001
SARS-CoV-2 infection in STEMI patients undergoing primary PCI is associated with impaired reperfusion, higher rates of stent thrombosis, and significantly increased in-hospital and 30-day mortality.
SARS-CoV-2 positivity was associated with higher STEMI mortality and stent thrombosis; leaves open causal mechanisms and need for prospective confirmation.
SARS-Cov-2 has been suggested to promote thrombotic complications and higher mortality. The aim of the present study was to evaluate the impact of SARS-CoV-2 positivity on in-hospital outcome and 30-day mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) enrolled in the International Survey on Acute Coronary Syndromes ST-segment elevation Myocardial Infarction (ISACS-STEMI COVID-19 registry. The 109 SARS-CoV-2 positive patients were compared with 2005 SARS-CoV-2 negative patients. Positive patients were older ( P = .002), less often active smokers ( P = .002), and hypercholesterolemic ( P = .006), they presented more often later than 12 h ( P = .037), more often to the hub and were more often in cardiogenic shock ( P = .02), or requiring rescue percutaneous coronary intervention after failed thrombolysis (P < .0001). Lower postprocedural Thrombolysis in Myocardial Infarction 3 flow ( P = .029) and more thrombectomy ( P = .046) were observed. SARS-CoV-2 was associated with a significantly higher in-hospital mortality (25.7 vs 7%, adjusted Odds Ratio (OR) [95% Confidence Interval] = 3.2 [1.71-5.99], P < .001) in-hospital definite in-stent thrombosis (6.4 vs 1.1%, adjusted Odds Ratio [95% CI] = 6.26 [2.41-16.25], P < .001) and 30-day mortality (34.4 vs 8.5%, adjusted Hazard Ratio [95% CI] = 2.16 [1.45-3.23], P < .001), confirming that SARS-CoV-2 positivity is associated with impaired reperfusion, with negative prognostic consequences.
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Luca et al. (2022) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=2,114). SARS-CoV-2 positivity vs. SARS-CoV-2 negative was evaluated on In-hospital mortality (adjusted OR 3.2, 95% CI 1.71-5.99, p=<0.001). SARS-CoV-2 positivity in STEMI patients undergoing mechanical reperfusion was associated with significantly higher in-hospital mortality compared to negative patients (25.7% vs 7.0%, adjusted OR 3.2).
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