Key result
AMI hospitalization during early COVID-19 is linked to ~27% higher in-hospital mortality vs 2019.
Why the study?
There are limited national data on the trends and outcomes of patients hospitalized with acute myocardial infarction during the COVID-19 pandemic.
Does hospitalization during the early COVID-19 pandemic (2020) compared to the pre-pandemic period (2019) affect in-hospital mortality and revascularization rates in adult patients with acute myocardial infarction?
Cohort (n=1,709,480)
Yes
Does hospitalization during the early COVID-19 pandemic (2020) compared to the pre-pandemic period (2019) affect in-hospital mortality and revascularization rates in adult patients with acute myocardial infarction?
Odds Ratio: 1.27 (95% CI 1.23–1.32)
Absolute Event Rate: 9.2% vs 7.4%
p-value: p=<0.01
Higher AMI mortality with fewer revascularizations in 2020 signals need for surge preparedness; leaves open causal mechanisms and mitigation strategies.
BACKGROUND AND OBJECTIVES: There are limited national data on the trends and outcomes of patients hospitalized with acute myocardial infarction (AMI) during the coronavirus disease 2019 (COVID-19) pandemic. We aimed to evaluate the impact of early COVID-19 pandemic on the trends and outcomes of AMI using the National Inpatient Sample (NIS) database. METHODS: The NIS database was queried from January 2019 to December 2020 to identify adult (age ≥18 years) AMI hospitalizations and were categorized into ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) based on International Classification of Diseases, Tenth Revision, Clinical Modification codes. In addition, the in-hospital mortality, revascularization, and resource utilization of AMI hospitalizations early in the COVID-19 pandemic (2020) were compared to those in the pre-pandemic period (2019) using multivariate logistic and linear regression analysis. RESULTS: Amongst 1,709,480 AMI hospitalizations, 209,450 STEMI and 677,355 NSTEMI occurred in 2019 while 196,230 STEMI and 626,445 NSTEMI hospitalizations occurred in 2020. Compared with those in 2019, the AMI hospitalizations in 2020 had higher odds of in-hospital mortality (adjusted odds ratio [aOR], 1.27; 95% confidence interval [CI], [1.23-1.32]; p<0.01) and lower odds of percutaneous coronary intervention (aOR, 0.95 [0.92-0.99]; p=0.02), and coronary artery bypass graft (aOR, 0.90 [0.85-0.97]; p<0.01). CONCLUSIONS: We found a significant decline in AMI hospitalizations and use of revascularization, with higher in-hospital mortality, during the early COVID-19 pandemic period (2020) compared with the pre-pandemic period (2019). Further research into the factors associated with increased mortality could help with preparedness in future pandemics.
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Thyagaturu et al. (2024) conducted a cohort in Acute Myocardial Infarction (n=1,709,480). Early COVID-19 pandemic period (2020) vs. Pre-pandemic period (2019) was evaluated on In-hospital mortality (aOR 1.27, 95% CI 1.23-1.32, p=<0.01). Hospitalization for acute myocardial infarction during the early COVID-19 pandemic in 2020 was associated with significantly higher odds of in-hospital mortality compared to 2019 (aOR 1.27).
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