Open AccessAcute myocardial infarction in the Covid-19 era: Incidence, clinical characteristics and in-hospital outcomes—A multicenter registry
Author(s) -
Alexander Fardman,
Doron Zahger,
Katia Orvin,
Daniel Oren,
Natalia Kofman,
Jameel Mohsen,
Tsafrir Or,
Elad Asher,
Ronen Rubinshtein,
Jamal Jafari,
Roi Efraim,
Majdi Halabi,
Yacov Shacham,
Lior Fortis,
Tal Cohen,
Robert Klempfner,
Amit Segev,
Roy Beigel,
Shlomi Matetzky
Publication year - 2021
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0253524
Subject(s) - medicine , cardiogenic shock , myocardial infarction , killip class , heart failure , prospective cohort study , incidence (geometry) , clinical endpoint , cardiology , stroke (engine) , acute coronary syndrome , percutaneous coronary intervention , clinical trial , mechanical engineering , physics , optics , engineering
Background We aimed to describe the characteristics and in-hospital outcomes of ST-segment elevation myocardial infarction (STEMI) patients during the Covid-19 era. Methods We conducted a prospective, multicenter study involving 13 intensive cardiac care units, to evaluate consecutive STEMI patients admitted throughout an 8-week period during the Covid-19 outbreak. These patients were compared with consecutive STEMI patients admitted during the corresponding period in 2018 who had been prospectively documented in the Israeli bi-annual National Acute Coronary Syndrome Survey. The primary end-point was defined as a composite of malignant arrhythmia, congestive heart failure, and/or in-hospital mortality. Secondary outcomes included individual components of primary outcome, cardiogenic shock, mechanical complications, electrical complications, re-infarction, stroke, and pericarditis. Results The study cohort comprised 1466 consecutive acute MI patients, of whom 774 (53%) were hospitalized during the Covid-19 outbreak. Overall, 841 patients were diagnosed with STEMI: 424 (50.4%) during the Covid-19 era and 417 (49.6%) during the parallel period in 2018. Although STEMI patients admitted during the Covid-19 period had fewer co-morbidities, they presented with a higher Killip class (p value = .03). The median time from symptom onset to reperfusion was extended from 180 minutes (IQR 122–292) in 2018 to 290 minutes (IQR 161–1080, p < .001) in 2020. Hospitalization during the Covid-19 era was independently associated with an increased risk of the combined endpoint in the multivariable regression model (OR 1.65, 95% CI 1.03–2.68, p value = .04). Furthermore, the rate of mechanical complications was four times higher during the Covid-19 era (95% CI 1.42–14.8, p-value = .02). However, in-hospital mortality remained unchanged (OR 1.73, 95% CI 0.81–3.78, p-value = .16). Conclusions STEMI patients admitted during the first wave of Covid-19 outbreak, experienced longer total ischemic time, which was translated into a more severe disease status upon hospital admission, and a higher rate of in-hospital adverse events, compared with parallel period.