COVID-19 diagnosis in patients with STEMI tied to elevated in-hospital mortality

ByBrian Ellis

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In a cohort of patients with STEMI, a COVID-19 diagnosis significantly increased the rates of in-hospital mortality compared with patients without a COVID-19 diagnosis from the past year, according to new data.

Marwan Saad, MD, PhD, FACC, FSCAI, FESC, assistant professor of medicine and director of interventional structural heart research at the Warren Alpert Medical School of Brown University, and colleagues conducted the retrospective cohort study. They included 80,449 consecutive adult patients admitted between January 2019 and December 2020 with out-of-hospital or in-hospital STEMI at 509 U.S. centers in the Vizient Clinical Database.

In-hospital mortality served as the primary outcome measure. Researchers propensity-matched patients based on the likelihood of COVID-19 diagnosis, and compared patients with COVID-19 with those without COVID-19 during the previous calendar year.

Overall, the out-of-hospital STEMI arm featured 76,434 patients (64% aged 51 to 74 years; 70% men), while the in-hospital STEMI arm featured 4,015 patients (58% aged 51 to 74 years; 61% men). After propensity matching, there were 551 patients with COVID-19 and 2,755 patients without COVID-19 in the out-of-hospital STEMI group, and 252 patients with COVID-19 and 756 patients without COVID-19 in the in-hospital STEMI group.

Results indicated that COVID-19 status did not significantly impact the likelihood of patients with out-of-hospital STEMI receiving primary PCI. However, patients with in-hospital STEMI and COVID-19 demonstrated a significantly decreased likelihood of receiving invasive diagnostic or therapeutic coronary procedures than those without COVID-19.

For patients with out-of-hospital STEMI, a COVID-19 diagnosis elevated the rates of in-hospital mortality compared with those who did not have a diagnosis (15.2% vs. 11.2%; P = .007). Additionally, for the in-hospital STEMI cohort, a significant increase in in-hospital mortality was reported with a COVID-19 diagnosis (78.5% vs. 46.1%; P < .001).

“Among patients with STEMI, a concomitant diagnosis of COVID-19 was associated with significantly higher rates of in-hospital mortality,” the researchers wrote, adding that “further research is required to understand the potential mechanisms underlying this association.”

Alexander C. Fanaroff

In an accompanying editorial, Alexander C. Fanaroff, MD, MHS, assistant professor of medicine at the Hospital of the University of Pennsylvania, and colleagues wrote that this study, along with previous analyses, supports current recommendations from the Society of Cardiovascular Angiography and Interventions and the American College of Cardiology indicating that primary PCI is feasible in patients with COVID-19 with STEMI and should remain the primary reperfusion modality in the absence of futility markers.

“Recommendations to ‘self-quarantine’ for 2 weeks when symptoms of COVID-19 were present, some of which may be indistinguishable from symptoms of heart disease, such as dyspnea and cough, may have contributed to many patients delaying or forgoing necessary medical care,” Fanaroff and colleagues wrote. “As the pandemic continues and in potential future public health emergencies, it is imperative to emphasize the importance of timely care for patients with acute MI.”

Reference:

Fanaroff AC, et al. JAMA. 2021;doi:10.1001/jama.2021.19608.

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Sources/Disclosures

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Source:

Saad M, et al. JAMA. 2021;doi:10.1001/jama.2021.18890.

Disclosures: Saad reports no relevant financial disclosures. Fanaroff reports receiving personal fees from Intercept Pharmaceuticals outside the submitted work. Please see the study and editorial for the other authors’ relevant financial disclosures.