Key result
In-hospital STEMI among COVID-19 patients is linked to ~156% higher mortality.
Why the study?
The epidemiology, diagnostic and therapeutic approaches, and outcomes of STEMI in patients hospitalized with COVID-19 are not well characterized.
What is the incidence, management, and clinical outcome of in-hospital STEMI among patients hospitalized for COVID-19?
Observational (n=15,621)
Yes
What is the incidence, management, and clinical outcome of in-hospital STEMI among patients hospitalized for COVID-19?
In-hospital STEMI is a rare but highly fatal complication in COVID-19 patients, and is associated with low rates of coronary angiography and primary reperfusion.
Answers are grounded in this paper and cite their sources.
Identifies high-mortality STEMI subgroup in COVID-19 inpatients; leaves open optimal monitoring and intervention strategies.
Background Early reports from the COVID‐19 pandemic identified coronary thrombosis leading to ST‐segment–elevation myocardial infarction (STEMI) as a complication of COVID‐19 infection. However, the epidemiology of STEMI in patients with COVID‐19 is not well characterized. We sought to determine the incidence, diagnostic and therapeutic approaches, and outcomes in STEMI patients hospitalized for COVID‐19. Methods and Results Patients with data on presentation ECG and in‐hospital myocardial infarction were identified from January 14, 2020 to November 30, 2020, from 105 sites participating in the American Heart Association COVID‐19 Cardiovascular Disease Registry. Patient characteristics, resource use, and clinical outcomes were summarized and compared based on the presence or absence of STEMI. Among 15 621 COVID‐19 hospitalizations, 54 (0.35%) patients experienced in‐hospital STEMI. Among patients with STEMI, the majority (n=40, 74%) underwent transthoracic echocardiography, but only half (n=27, 50%) underwent coronary angiography. Half of all patients with COVID‐19 and STEMI (n=27, 50%) did not undergo any form of primary reperfusion therapy. Rates of all‐cause shock (47% versus 14%), cardiac arrest (22% versus 4.8%), new heart failure (17% versus 1.4%), and need for new renal replacement therapy (11% versus 4.3%) were multifold higher in patients with STEMI compared with those without STEMI ( P <0.050 for all). Rates of in‐hospital death were 41% in patients with STEMI, compared with 16% in those without STEMI ( P <0.001). Conclusions STEMI in hospitalized patients with COVID‐19 is rare but associated with poor in‐hospital outcomes. Rates of coronary angiography and primary reperfusion were low in this population of patients with STEMI and COVID‐19. Adaptations of systems of care to ensure timely contemporary treatment for this population are needed.
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A 2022 study conducted an observational in COVID-19 and ST-segment-elevation myocardial infarction (STEMI) (n=15,621). In-hospital STEMI vs. Absence of STEMI was evaluated on In-hospital death (p=<0.001). In-hospital STEMI in COVID-19 patients was rare (0.35%) but associated with significantly higher rates of in-hospital death compared to those without STEMI (41% vs 16%; P<0.001).
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