Next Article in Journal
Radiomic Analysis of Quantitative T2 Mapping and Conventional MRI in Predicting Histologic Grade of Bladder Cancer
Previous Article in Journal
Effect of Dapagliflozin on Patients with Rheumatic Heart Disease Mitral Stenosis
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
JCM
Volume 12
Issue 18
10.3390/jcm12185899
jcm-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

The Influence of SARS-CoV-2 Infection on Acute Myocardial Infarction Outcomes

by
Eugeniusz Hrycek
1,2,*,
Anna Walawska-Hrycek
3,
Maciej Hamankiewicz
4,
Krzysztof Milewski
5,
Przemysław Nowakowski
1,6,
Piotr Buszman
2,5 and
Aleksander Żurakowski
1,2
1
American Heart of Poland, Topolowa 16, 32-500 Chrzanów, Poland
2
Department of Cardiology, Faculty of Medical Sciences, Andrzej Frycz Modrzewski Kraków University, 30-705 Kraków, Poland
3
Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
4
American Heart of Poland, Warszawska 52, 40-008 Katowice, Poland
5
American Heart of Poland, Armii Krajowej 101, 43-316 Bielsko-Biała, Poland
6
Department of Vascular Surgery, Faculty of Medical Sciences, University of Technology, Rolna 43, 40-555 Katowice, Poland
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2023, 12(18), 5899; https://doi.org/10.3390/jcm12185899
Submission received: 30 July 2023 / Revised: 30 August 2023 / Accepted: 9 September 2023 / Published: 11 September 2023
(This article belongs to the Section Cardiovascular Medicine)
Browse Figures
Versions Notes

Abstract

:
Background: This multicenter retrospective study with a control group was designed to assess the influence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the outcomes of patients with myocardial infarction (MI). Methods: A total of 129 patients with COVID-19 who were treated for MI were included in this study. The control group comprised 129 comparable patients without SARS-CoV-2 infection. The in-hospital, out-of-hospital, and overall mortality were analyzed. Results: A total of thirty-one (24%) patients died in the study group, and two (1.6%) patients died in the control group (OR = 20.09; CI: 4.69–85.97; p < 0.001). Similar results were observed in all analyzed patient subgroups. Multivariable Cox regression analysis confirmed the significant influence of SARS-CoV-2 infection on in-hospital outcomes (HR: 8.48459; CI: 1.982–36.320; p = 0.004). Subanalysis of the groups with COVID-19 plus ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI) revealed comparable mortality rates: 14 (21.12%) patients in the NSTEMI group and 17 (26.98%) patients in the STEMI subgroup died (OR: 1.3; CI: 0.56–3.37; p = 0.45). During out-of-hospital observation, no differences in mortality were observed (OR: 0.77; CI: 0.11–4.07; p = 0.73). Conclusions: SARS-CoV-2 infection affects the in-hospital outcomes of patients with both MI and COVID-19, regardless of MI type (STEMI vs. NSTEMI).

1. Introduction

Since 2019, coronavirus disease 2019 (COVID-19) has become an overwhelming and growing challenge for healthcare systems. This disease is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a single-stranded RNA virus that is a member of the coronavirus family and was initially identified in Wuhan, China. SARS-CoV-2 enters cells via the angiotensin-converting enzyme 2 receptor, which is essential for adequate functioning of the circulatory system. COVID-19 can be divided into three stages: early infection, pulmonary involvement (IIa without or IIb with hypoxia), and systemic hyperinflammation (cytokine storm) [1]. The last stage, similarly to myocardial infarction (MI), is associated with uncontrolled propagation of inflammation mediated by molecules including IL-2, IL-6, IL-7, granulocyte colony-stimulating factor, macrophage inflammatory protein 1-α, tumor necrosis factor-α, C-reactive protein, ferritin, and D-dimer [2].
Several studies have demonstrated that COVID-19 affects cardiovascular system function. COVID-19 alone has been shown to increase the risk of thrombotic events, including MI, acute limb ischemia, abdominal and thoracic aortic thrombosis, mesenteric ischemia, pulmonary embolism, stroke, and disseminated intravascular coagulation. COVID-19 can cause heart muscle inflammation and injury in an MI-independent manner. At the health care system level, COVID-19 may perturb acute coronary syndrome hospitalization pathways, thus decreasing the rate of MI hospitalizations [3,4,5,6,7,8,9] worldwide, delaying patients’ contact with medical services [10,11,12] and emergency department arrival times of patients with suspected acute coronary syndrome [13] and increasing the door-to-balloon time [14,15,16], scar size (as confirmed with cardiac magnetic resonance) [17], and rate of mechanical complications. Moreover, during the COVID-19 pandemic, the prolongation of time from the first medical contact to revascularization was revealed in a group of patients with STEMI and out-of-hospital cardiac arrest [18]. At the procedural level, COVID-19 is a factor increasing the risk of aspiration thrombectomy [19]. Some studies have shown that SARS-CoV-2 infection alone can be classified as a risk factor/trigger of MI [20]. Regardless of the above associations, the results of studies assessing the global influence of the COVID-19 pandemic on the mortality of patients with MI have been inconsistent: some studies have indicated elevated in-hospital mortality [21,22,23,24,25,26], whereas others have not [9,27]. Consequently, this multicenter retrospective study with a control group was designed to assess the influence of SARS-CoV-2 infection on treatments and outcomes in patients with MI.

2. Materials and Methods

2.1. Study Group

Among 6490 patients with MI treated in 11 American Heart of Poland Cardiology Departments from 4 March 2020 (the date of the first identified COVID-19 case in Poland) until 4 March 2022 (spanning the first 2 years of the COVID-19 pandemic), 165 patients with COVID-19 were identified. The patients were considered COVID-19-positive on the basis of PCR test results. Hospitalization histories were analyzed retrospectively. The minimum follow-up time was 1 month, and the maximum follow-up time was 6 months. All inclusion criteria were based on the participants’ medical records. Patients were recruited according to the following inclusion criteria:
  • Confirmed MI, according to the ESC Fourth Universal Definition of Myocardial Infarction;
  • Active SARS-CoV-2 infection confirmed during hospitalization by PCR testing;
  • Age > 18 years.
All exclusion criteria were based on the participants’ medical records. The exclusion criteria were as follows:
  • Any coexisting disease potentially limiting lifetime during observation (e.g., any end-stage organ failure or end-stage cancer);
  • Minimum follow-up duration not met;
  • Lack of primary clinical data necessary for matching, e.g., glomerular filtration rate (GFR) or ejection fraction (EF).
Thirty-six patients were excluded from this study on the basis of the following criteria: end-stage disease (two patients, 5.5%), minimum follow-up duration not met (fourteen patients, 38.9%), and insufficient data to identify matching patients (twenty patients, 55.5%). Ethical approval was not obtained because all data were collected during standard care procedures.

2.2. Study Objectives and Endpoints

The primary objective of this study was to assess the influence of SARS-CoV-2 infection on in-hospital mortality in patients treated for MI and COVID-19 simultaneously. The secondary objectives of this study were as follows: assessment of the influence of SARS-CoV-2 infection on out-of-hospital mortality among patients previously treated for MI and COVID-19 simultaneously and assessment of the influence of basic clinical parameters on in-hospital mortality among patients treated for MI and COVID-19 simultaneously. The primary endpoint was defined as the time to in-hospital death. The secondary endpoint was defined as the time to out-of-hospital death.

2.3. Methods

The study scheme is presented in Figure 1.
All clinical data were retrospectively obtained from the American Heart of Poland patient database. After the creation of the study group, the control group was created by selecting 1:1 comparable patients in terms of age, sex, diabetes mellitus (DM) presence, MI type, initial ejection fraction, and initial GFR. The accuracy of matching was additionally verified using propensity score. Then, subsequent analysis was conducted. To assess the primary objective of this study, we compared overall in-hospital mortality between the study group and control group. The analysis was extended to compare in-hospital mortality in subgroups of patients according to MI type (ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI)), sex (male or female), presence of heart failure with reduced ejection fraction (EFrEF; HFrEF subgroup and no HFrEF subgroup), presence of DM, and need for intensive care unit (ICU) hospitalization. In COVID-19 subgroups, additional analyses compared in-hospital mortality in STEMI vs. NSTEMI and ICU patients vs. the rest of the COVID-19 group. The analysis was extended to outcome predictors in the overall group (including both the study group and the control group). Finally, out-of-hospital mortality was assessed in the study group vs. the controls. To achieve comparable overall observation time (including both in-hospital and out-of-hospital observations), we extended the follow-up to 6 months. In-hospital mortality and overall mortality were analyzed.

2.4. Statistical Analysis

Statistical analysis was performed in PQStata version 1.8.4 (PQStat Software) and MedCalc version 20.106 (MedCalc Software). The obtained data are presented as percentages, means and standard deviations (for parametric data), or medians with interquartile ranges (for nonparametric data). The following statistical tests were applied: Shapiro–Wilk test (for normality assessment), Student’s t-test (for difference analysis of data with a normal distribution), Mann–Whitney U test (for difference analysis of data with a nonparametric distribution), and chi-square test (for proportion difference analysis). Propensity score matching was used to create the control group. Kaplan–Meier plots were used for survival analysis. Cox proportional hazard models were used to analyze the influence of selected risk factors on survival. Results were considered statistically significant if p < 0.05 and highly statistically significant if p < 0.001.

2.5. Sample Size Determination

The minimum total sample size (for both groups together) for the comparison of two proportions with type I error of 0.05 and type II error of 0.2 was estimated to be 68. For Cox multivariable proportional hazard regression, the minimum number of cases to be included in this study was established to be 204.

2.6. Rationale for Study Design

This article provides an overview of the influence of SARS-CoV-2 infection on the mortality of patients simultaneously being treated for MI. In contrast to most reports, the observation time in this study was prolonged for as many as 6 months to obtain both in-hospital and out-of-hospital observations. Whereas most prior articles have focused on patients with STEMI, patients with both STEMI and NSTEMI were included herein. The presented data provide rare evidence that SARS-CoV-2 infection influences the in-hospital outcomes of patients with NSTEMI. Additionally, the roles of COVID-19 and respiratory failure as outcome predictors among patients treated for MI were assessed.

3. Results

3.1. Study Group

A total of 165 patients treated for MI were COVID-19-positive. SARS-CoV-2 infection was present in 25.4 of every 1000 patients with MI (2.5%). Of all patients with COVID-19, 129 met the inclusion criteria and were included in this study. The study group ultimately consisted of 92 men (71.32%), 37 women (28.68%), 63 patients with STEMI (48.84%), and 66 patients with NSTEMI (51.16%). The control group consisted of 129 patients with MI without COVID-19. The groups were comparable in age, sex, MI type, coexisting DM, EF, and initial GFR. The demographic and clinical characteristics of the study group and the control group are presented in Table 1, clinical characteristics section.
The procedural characteristics are presented in Table 1, procedural characteristics section. No differences between the study and control groups were observed in qualification for percutaneous coronary intervention, coronary artery bypass grafting (CABG), optimal medical treatment, overall length of implanted stents, and the number of treated vessels. The hospitalization characteristics are presented in Table 1, hospitalization characteristics section. Subsequent differences in hospitalizations were identified. Cardiac shock was observed in eighteen (13.95%) patients in the study group and eight (6.2%) patients in the control group (p = 0.04). Respiratory failure requiring mechanical ventilation was observed in 23 (17.83%) patients who were finally transferred to the ICU in the study group and no patients in the control group (p < 0.001). Bleeding requiring transfusion was observed in five (3.88%) patients in the study group and no patients in the control group (p = 0.02).

3.2. In-Hospital Mortality and Survival Analysis

A total of thirty-one (24%) patients died in the study group, whereas two (1.6%) patients died in the control group (OR = 20.09; CI: 4.69–85.97; p < 0.001; Figure 2).
When all patients were included, regardless of the availability of clinical data to identify matching patients (142 patients), the overall in-hospital mortality in the study group was even higher: 41 (28.9%) patients died. Similar results were observed in all analyzed patient subgroups (Figure 3A).
The greatest increase in mortality (87%) was observed in the subgroup of patients requiring ICU hospitalization (87.0% vs. 4.3%; OR = 146.67; CI: 12.20–6011.08; p < 0.001; Figure 3). The obtained data were verified with both univariable and multivariable Cox regression models, thus confirming the significant influence of SARS-CoV-2 infection on in-hospital outcomes (HR: 9.10; CI: 2.12–39.00; p = 0.003; Table 2). Moreover, the results indicated the value of acute respiratory failure development (treated with mechanical ventilation) in predicting the fatal outcome, with high statistical significance (HR: 6.80; CI: 3.32–13.94; p < 0.001).
Additional analysis was conducted in the COVID-19 subgroup (STEMI vs. NSTEMI and ICU vs. non-ICU). The mortality in the STEMI and NSTEMI COVID-19 subgroups was comparable: 14 (21.12%) patients died in the NSTEMI subgroup, and 17 (26.98%) patients died in the STEMI subgroup (OR: 1.3; CI: 0.56–3.37; p = 0.45). In addition, the mortality was comparable in patients with COVID-19 between the first and second years of the pandemic (OR: 1.36; CI: 0.53–3.39; p = 0.46). The lack of influence of pandemic year was also confirmed with univariable Cox regression (HR: 0.86; CI: 0.42–1.79; p = 0.75). The in-hospital mortality in the ICU subgroup was higher than that in the non-ICU subgroup, at 20 patients (86.96%) vs. 11 patients (10.38%; OR = 54.16; CI: 13.27–327.50; p < 0.001). Figure 3B presents the overall (including in-hospital and out-of-hospital) mortality in the COVID-19 intensive care unit patient subgroup vs. COVID-19 non-intensive care unit patient subgroup.
During out-of-hospital observation, three (3.06%) patients died in the study group, and five patients (3.94%) died in the control group (OR: 0.77; CI: 0.11–4.07; p = 0.73). During the overall observation period (including both in-hospital and out-of-hospital data), thirty-four (26.4%) patients died in the study group, whereas eight (6.2%) patients died in the control group (HR: 5.47; CI: 2.96–10.10; p < 0.001; Figure 4).

4. Discussion

In-hospital mortality can be as high as 7% in patients with STEMI and 4.9% in patients with NSTEMI [28]. On the basis of WHO data, the COVID-19 mortality in the general population is approximately 3.4% [29] and ranges from 0.1% to 5.2%. In contrast, the seasonal influenza mortality has been estimated to be <1%. Among hospitalized patients with COVID-19, the mortality has been reported to be approximately 21% [30]. The frequency of COVID-19 in patients treated for STEMI reached up to 1% in epidemiological studies [31,32]. In our study it was 2.5%. The obtained result may be a positive consequence of performed cyclical PCR screening tests as a standard of care in treated patients. The mortality in patients with COVID-19 and coexisting MI varies from 10% to 76.6%. Lower mortality rates have often been observed in earlier studies. Perioperatively, the mortality rate reached 1.29% in patients with STEMI treated for COVID-19 [19]. In later, more complex studies covering the full period of hospitalization, the mortality has reached approximately 30%, regardless of geographic region. Most of the obtained results have been statistically significant. Among the relevant studies, only Choudry et al. observed a numerical but not statistically significant difference in the mortality of COVID-19 patients. In addition, Zajac et al. did not observe a statistical difference in mortality. However, in that study, the observation time was limited to the procedure [19,32,33,34,35,36,37,38,39,40,41]. Among cited studies, only Kite et al. and Markson et al. assessed outcomes among patients with NSTEMI [37]. In their studies, the mortality in the STEMI group was higher (6.6% vs. 21.1% and 9.1% vs. 17.2%, respectively), in contrast to the findings in our study, in which the mortality was similar between NSTEMI and STEMI.
The mortality rate of patients with HF and COVID-19 can reach 45% [42,43,44,45,46]. Moreover, hospital outcomes depend on the initial EF in patients with COVID-19 [47]. Various studies and meta-analyses have demonstrated that DM strongly affects COVID-19 in-hospital mortality, which has been found to reach 22.14% [48]. In patients requiring invasive mechanical ventilation or ICU hospitalization, the mortality ranges from 9.9% to 78.4% and commonly exceeds 30% [49,50].
Our risk factor analysis results slightly differed from those reported by other authors. In the present study, COVID-19 and respiratory failure were identified as the main risk factors for fatal outcomes. Additionally, the EF appeared to slightly modify the mortality risk, which is a common result observed in patients with MI. These factors were not included in other analyses. In a study by Kazirod-Wolski et al., age and STEMI type were identified as predictors of periprocedural fatal outcomes, whereas our analysis did not indicate similar results. The difference between studies may be a consequence of different observation times (assessment during the full hospitalization time herein vs. the periprocedural period in other studies) [51].
In various studies, fluctuations in mortality have been observed among subsequent pandemic waves. Some studies have indicated an increasing mortality trend [52], whereas others have documented a decreasing mortality trend [53,54,55]. In the present study, no statistical differences in mortality were observed between the first and the second years of the pandemic. Moreover, the pandemic year did not reach statistical significance in the regression model. These results indicate that SARS-CoV-2 infection can strongly and permanently influence the outcomes of patients with MI. The number of patients increased between the first and second years of the pandemic, in agreement with other authors’ observations [8].
The obtained data yielded several conclusions. The mortality rate in the overall COVID-19 group and subgroups was higher than that in the control group. These results are comparable to those obtained by other researchers. The mortality rate in the DM subgroup was slightly higher than those reported in other studies [48,56,57], possibly because of the elevated overall mortality of patients with DM treated for MI [58,59]. The mortality in HF patients with COVID-19 can reach 50% [43,60,61,62,63]. In the present study, the mortality rate in the HF subgroup was slightly lower. However, in studies assessing the influence of COVID-19 on in-hospital outcomes in patients with HF, the EF was often unknown, whereas the present study relied on echocardiographic assessment during hospitalization. Potential differences in EF may be a reason for the observed incompatibility in in-hospital outcomes. Moreover, comparison between HF groups may be difficult because of their heterogeneity, including different etiologies and a variety of possible coexisting diseases. In the present study, the respiratory failure frequency was higher in the study group than in the control group and appeared to be the main reason for the increased mortality. We also observed that the cardiac shock frequency was higher in the study group, possibly as a consequence of COVID-19-mediated heart muscle injury. Cardiac shock also contributed to elevated mortality in the study group. Similar observations have been reported by Kite et al. [37].
In contrast to other studies focusing mainly on patients with STEMI, this study examined a heterogeneous group including both patients with STEMI and NSTEMI. Most previous studies have excluded patients with NSTEMI. The difference in mortality between patients with STEMI and NSTEMI has been considered only by Kite et al. [37], who have observed greater mortality in patients with STEMI than NSTEMI. In contrast, our results indicated comparable mortality between STEMI and NSTEMI groups. Moreover, whereas other studies have focused only on in-hospital observations, the present research was extended to 6 months, including out-of-hospital follow-up. On the basis of the presented data, the higher morality observed in patients with COVID-19 was a consequence of in-hospital mortality.

5. Study Limitations

Before the statistical analysis, 36 patients were excluded from this study (mainly because of insufficient clinical data), and their outcomes were difficult to compare. The results might have been biased because of the relatively small size of the study group. The study did not reach sufficient statistical power to include the Grace score in the Cox model analysis. Multiple comparisons between the study group and the control group were not conducted because most of the obtained data did not reach normal distribution.

6. Conclusions

On the basis of the presented results, we reached the following conclusions. SARS-CoV-2 infection significantly affects the in-hospital outcomes of patients with both COVID-19 and MI. An elevated frequency of both respiratory failure and cardiac shock explained the elevated mortality observed among patients with COVID-19 treated for MI.

Author Contributions

Conceptualization, E.H.; data curation, E.H.; formal analysis, E.H. and A.W.-H.; investigation, E.H.; methodology, E.H.; resources, E.H.; software, E.H.; supervision, K.M., P.N., P.B. and A.Ż.; visualization, E.H. and A.W.-H.; writing—original draft, E.H., A.W.-H. and M.H.; writing—review and editing, E.H. All authors have read and agreed to the published version of this manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Ethical review and approval were waived for this study because, all data were collected during standard care procedures.

Informed Consent Statement

Patient consent was waived because all data were collected during standard care procedures.

Data Availability Statement

Derived data supporting the findings of this study are available from the corresponding author on request.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Siddiqi, H.K.; Mehra, M.R. COVID-19 Illness in Native and Immunosuppressed States: A Clinical–Therapeutic Staging Proposal. J. Heart Lung Transplant. 2020, 39, 405–407. [Google Scholar] [CrossRef]
  2. Wu, C.; Chen, X.; Cai, Y.; Xia, J.; Zhou, X.; Xu, S.; Huang, H.; Zhang, L.; Zhou, X.; Du, C.; et al. Risk Factors Associated with Acute Respiratory Distress Syndrome and Death in Patients with Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern. Med. 2020, 180, 934–943. [Google Scholar] [CrossRef]
  3. Schmitz, T.; Meisinger, C.; Kirchberger, I.; Thilo, C.; Amann, U.; Baumeister, S.E.; Linseisen, J. Impact of COVID-19 Pandemic Lockdown on Myocardial Infarction Care. Eur. J. Epidemiol. 2021, 36, 619–627. [Google Scholar] [CrossRef]
  4. Gylfason, A.D.; Bjarnason, A.; Helgason, K.O.; Rognvaldsson, K.G.; Armannsdottir, B.; Gudmundsdottir, I.J.; Gottfredsson, M. Effects of the COVID-19 pandemic and associated non-pharmaceutical interventions on diagnosis of myocardial infarction and selected infections in Iceland 2020. Laeknabladid 2022, 108, 182–188. [Google Scholar] [CrossRef]
  5. Impact of the COVID-19 Pandemic on Patient Delay and Clinical Outcomes for Patients with Acute Myocardial Infarction. Available online: https://pubmed.ncbi.nlm.nih.gov/35638194/ (accessed on 19 June 2023).
  6. Pourasghari, H.; Tavolinejad, H.; Soleimanpour, S.; Abdi, Z.; Arabloo, J.; Bragazzi, N.L.; Behzadifar, M.; Rashedi, S.; Omidi, N.; Ayoubian, A.; et al. Hospitalization, Major Complications and Mortality in Acute Myocardial Infarction Patients during the COVID-19 Era: A Systematic Review and Meta-Analysis. Int. J. Cardiol. Heart Vasc. 2022, 41, 101058. [Google Scholar] [CrossRef]
  7. Wang, S.Y.; Seghieri, C.; Vainieri, M.; Groene, O. Changes in Acute Myocardial Infarction, Stroke, and Heart Failure Hospitalizations during COVID-19 Pandemic in Tuscany—An Interrupted Time Series Study. Int. J. Public Health 2022, 67, 1604319. [Google Scholar] [CrossRef]
  8. Griewing, S.; Gremke, N.; Kreutz, J.; Schieffer, B.; Timmermann, L.; Markus, B. Chronological Development of Cardiovascular Disease in Times of COVID-19: A Retrospective Analysis of Hospitalized Diseases of the Circulatory System and COVID-19 Patients of a German University Hospital. J. Cardiovasc. Dev. Dis. 2022, 9, 325. [Google Scholar] [CrossRef]
  9. Zeymer, U.; Ahmadli, V.; Schneider, S.; Werdan, K.; Weber, M.; Hohenstein, S.; Hindricks, G.; Desch, S.; Bollmann, A.; Thiele, H. Effects of the COVID-19 Pandemic on Acute Coronary Syndromes in Germany during the First Wave: The COVID-19 Collateral Damage Study. Clin. Res. Cardiol. 2023, 112, 539–549. [Google Scholar] [CrossRef]
  10. Sturkenboom, H.N.; van Hattem, V.A.E.; Nieuwland, W.; Paris, F.M.A.; Magro, M.; Anthonio, R.L.; Algin, A.; Lipsic, E.; Bruwiere, E.; Van den Branden, B.J.L.; et al. COVID-19-Mediated Patient Delay Caused Increased Total Ischaemic Time in ST-Segment Elevation Myocardial Infarction. Neth. Heart J. 2022, 30, 96–105. [Google Scholar] [CrossRef]
  11. McNamara, D.A.; VanOosterhout, S.; Klungle, D.; Busman, D.; Parker, J.L.; Kampfschulte, A.; Jovinge, S.; Wohns, D.; Madder, R.D. Pandemic-Associated Delays in Myocardial Infarction Presentation in Predominantly Rural Counties with Low COVID-19 Prevalence. Am. J. Cardiol. 2022, 169, 18–23. [Google Scholar] [CrossRef]
  12. Granström, J.; Lantz, P.; Lidin, M.; Wahlström, M.; Nymark, C. Perceptions of Delay When Afflicted by an Acute Myocardial Infarction during the First Wave of the COVID-19 Pandemic. Eur. J. Cardiovasc. Nurs. 2023, 22, 89–97. [Google Scholar] [CrossRef]
  13. Janke, A.T.; Gettel, C.J.; Haimovich, A.; Kocher, K.E.; Krumholz, H.M.; Venkatesh, A.K. Changes in Emergency Department Arrival Times for Acute Myocardial Infarction during the COVID-19 Pandemic Suggest Delays in Care Seeking. Circ. Cardiovasc. Qual. Outcomes 2022, 15, e008402. [Google Scholar] [CrossRef]
  14. Mao, Q.; Zhao, J.; Li, Y.; Xie, L.; Xiao, H.; Wang, K.; Qiu, Y.; Chen, J.; Xu, Q.; Xu, Z.; et al. Impact of COVID-19 Pandemic on Mechanical Reperfusion in ST-Segment-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Multicenter Retrospective Study from a Non-Epicenter Region. Front. Cardiovasc. Med. 2021, 8, 698923. [Google Scholar] [CrossRef]
  15. Budrys, P.; Lizaitis, M.; Cerlinskaite-Bajore, K.; Bajoras, V.; Rodevic, G.; Martinonyte, A.; Dieckus, L.; Badaras, I.; Serpytis, P.; Gurevicius, R.; et al. Increase of Myocardial Ischemia Time and Short-Term Prognosis of Patients with Acute Myocardial Infarction during the First COVID-19 Pandemic Wave. Medicina 2021, 57, 1296. [Google Scholar] [CrossRef]
  16. Kobayashi, S.; Sakakura, K.; Jinnouchi, H.; Taniguchi, Y.; Tsukui, T.; Watanabe, Y.; Yamamoto, K.; Seguchi, M.; Wada, H.; Fujita, H. Comparison of Door-to-Balloon Time and in-Hospital Outcomes in Patients with ST-Elevation Myocardial Infarction between before versus after COVID-19 Pandemic. Cardiovasc. Interv. Ther. 2022, 37, 641–650. [Google Scholar] [CrossRef]
  17. Lechner, I.; Reindl, M.; Tiller, C.; Holzknecht, M.; Troger, F.; Fink, P.; Mayr, A.; Klug, G.; Bauer, A.; Metzler, B.; et al. Impact of COVID-19 Pandemic Restrictions on ST-Elevation Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study. Eur. Heart J. 2022, 43, 1141–1153. [Google Scholar] [CrossRef]
  18. Tokarek, T.; Dziewierz, A.; Zeliaś, A.; Malinowski, K.P.; Rakowski, T.; Dudek, D.; Siudak, Z. Impact of COVID-19 Pandemic on Patients with ST-Segment-Elevation Myocardial Infarction Complicated by Out-of-Hospital Cardiac Arrest. Int. J. Environ. Res. Public Health 2022, 20, 337. [Google Scholar] [CrossRef]
  19. Zając, P.; Kaziród-Wolski, K.; Sielski, J.; Wolska, M.; Malinowski, K.P.; Siudak, Z. COVID-19 as an Independent Predictor of Aspiration Thrombectomy in STEMI. National Data from the ORPKI Register in the Years 2020–2022. Postep. Kardiol Interwencyjnej 2023, 19, 119–126. [Google Scholar] [CrossRef]
  20. Katsoularis, I.; Fonseca-Rodríguez, O.; Farrington, P.; Lindmark, K.; Fors Connolly, A.-M. Risk of Acute Myocardial Infarction and Ischaemic Stroke Following COVID-19 in Sweden: A Self-Controlled Case Series and Matched Cohort Study. Lancet 2021, 398, 599–607. [Google Scholar] [CrossRef]
  21. Wienbergen, H.; Retzlaff, T.; Schmucker, J.; Marin, L.A.M.; Rühle, S.; Garstka, D.; Osteresch, R.; Fach, A.; Hambrecht, R. Impact of COVID-19 Pandemic on Presentation and Outcome of Consecutive Patients Admitted to Hospital Due to ST-Elevation Myocardial Infarction. Am. J. Cardiol. 2021, 151, 10–14. [Google Scholar] [CrossRef]
  22. Impact of COVID-19 Outbreak on Patients with ST-Segment Elevation Myocardial Infarction (STEMI) in Turkey: Results from TURSER Study (TURKISH St-Segment Elevation Myocardial Infarction Registry). Available online: https://pubmed.ncbi.nlm.nih.gov/34050883/ (accessed on 19 June 2023).
  23. Rattka, M.; Winsauer, C.; Stuhler, L.; Thiessen, K.; Baumhardt, M.; Stephan, T.; Rottbauer, W.; Imhof, A. Outcomes of Patients with ST-Segment Myocardial Infarction Admitted during the COVID-19 Pandemic. Herz 2022, 47, 258–264. [Google Scholar] [CrossRef]
  24. One-Year Outcomes of Patients with ST-Segment Elevation Myocardial Infarction during the COVID-19 Pandemic. Available online: https://pubmed.ncbi.nlm.nih.gov/34448103/ (accessed on 19 June 2023).
  25. De Luca, G.; Algowhary, M.; Uguz, B.; Oliveira, D.C.; Ganyukov, V.; Zimbakov, Z.; Cercek, M.; Jensen, L.O.; Loh, P.H.; Calmac, L.; et al. COVID-19 Pandemic, Mechanical Reperfusion and 30-Day Mortality in ST Elevation Myocardial Infarction. Heart 2022, 108, 458–466. [Google Scholar] [CrossRef]
  26. Fox, D.K.; Waken, R.J.; Johnson, D.Y.; Hammond, G.; Yu, J.; Fanous, E.; Maddox, T.M.; Joynt Maddox, K.E. Impact of the COVID-19 Pandemic on Patients without COVID-19 with Acute Myocardial Infarction and Heart Failure. J. Am. Heart Assoc. 2022, 11, e022625. [Google Scholar] [CrossRef]
  27. Asher, E.; Alexander Fardman, M.; Shmueli, H.; Orvin, K.; Oren, D.; Kofman, N.; Mohsen, J.; Moady, G.; Taha, L.; Rubinshtein, R.; et al. Outcomes among Patients Admitted for Non-ST Segment Myocardial Infarction in the Pre Pandemic and Pandemic COVID-19 Era–Israel Nationwide Study. Int. J. Qual. Health Care 2022, 34, mzac085. [Google Scholar] [CrossRef]
  28. Kontos, M.C.; Rennyson, S.L.; Chen, A.Y.; Alexander, K.P.; Peterson, E.D.; Roe, M.T. The Association of Myocardial Infarction Process of Care Measures and In-Hospital Mortality: A Report from the NCDR®. Am. Heart J. 2014, 168, 766–775. [Google Scholar] [CrossRef]
  29. WHO Director-General’s Opening Remarks at the Media Briefing on COVID-19—3 March 2020. Available online: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---3-march-2020 (accessed on 19 June 2023).
  30. Marik, P.E.; Iglesias, J.; Varon, J.; Kory, P. COVID-19 in-Hospital Mortality: A Concise Worldwide Review. J. Comm. Med. Public Health Rep. 2021, 2, 1–8. [Google Scholar] [CrossRef]
  31. Alharbi, A.; Franz, A.; Alfatlawi, H.; Wazzan, M.; Alsughayer, A.; Eltahawy, E.; Assaly, R. Impact of COVID-19 Pandemic on the Outcomes of Acute Coronary Syndrome. Curr. Probl. Cardiol. 2023, 48, 101575. [Google Scholar] [CrossRef]
  32. Markson, F.E.; Akuna, E.; Lim, C.Y.; Khemani, L.; Amanullah, A. The Impact of COVID-19 on Hospitalization Outcomes of Patients with Acute Myocardial Infarction in the USA. Am. Heart J. Plus 2023, 32, 100305. [Google Scholar] [CrossRef]
  33. Saad, M.; Kennedy, K.F.; Imran, H.; Louis, D.W.; Shippey, E.; Poppas, A.; Wood, K.E.; Abbott, J.D.; Aronow, H.D. Association between COVID-19 Diagnosis and In-Hospital Mortality in Patients Hospitalized with ST-Segment Elevation Myocardial Infarction. JAMA 2021, 326, 1940–1952. [Google Scholar] [CrossRef]
  34. Little, C.D.; Kotecha, T.; Candilio, L.; Jabbour, R.J.; Collins, G.B.; Ahmed, A.; Connolly, M.; Kanyal, R.; Demir, O.M.; Lawson, L.O.; et al. COVID-19 Pandemic and STEMI: Pathway Activation and Outcomes from the Pan-London Heart Attack Group. Open Heart 2020, 7, e001432. [Google Scholar] [CrossRef]
  35. Choudry, F.A.; Hamshere, S.M.; Rathod, K.S.; Akhtar, M.M.; Archbold, R.A.; Guttmann, O.P.; Woldman, S.; Jain, A.K.; Knight, C.J.; Baumbach, A.; et al. High Thrombus Burden in Patients with COVID-19 Presenting with ST-Segment Elevation Myocardial Infarction. J. Am. Coll. Cardiol. 2020, 76, 1168–1176. [Google Scholar] [CrossRef]
  36. Garcia, S.; Dehghani, P.; Grines, C.; Davidson, L.; Nayak, K.R.; Saw, J.; Waksman, R.; Blair, J.; Akshay, B.; Garberich, R.; et al. Initial Findings from the North American COVID-19 Myocardial Infarction Registry. J. Am. Coll. Cardiol. 2021, 77, 1994–2003. [Google Scholar] [CrossRef]
  37. Kite, T.A.; Ludman, P.F.; Gale, C.P.; Wu, J.; Caixeta, A.; Mansourati, J.; Sabate, M.; Jimenez-Quevedo, P.; Candilio, L.; Sadeghipour, P.; et al. International Prospective Registry of Acute Coronary Syndromes in Patients with COVID-19. J. Am. Coll. Cardiol. 2021, 77, 2466–2476. [Google Scholar] [CrossRef]
  38. Choudry, F.A.; Rathod, K.S.; Baumbach, A.; Mathur, A.; Jones, D.A. Long-Term Outcomes of COVID-19-Associated ST-Elevation Myocardial Infarction Treated with Primary PCI. Cardiovasc. Revasc. Med. 2022, 43, 133–135. [Google Scholar] [CrossRef]
  39. Dehghani, P.; Schmidt, C.W.; Garcia, S.; Okeson, B.; Grines, C.L.; Singh, A.; Patel, R.A.G.; Wiley, J.; Htun, W.W.; Nayak, K.R.; et al. North American COVID-19 Myocardial Infarction (NACMI) Risk Score for Prediction of In-Hospital Mortality. J. Soc. Cardiovasc. Angiogr. Interv. 2022, 1, 100404. [Google Scholar] [CrossRef]
  40. De Luca, G.; Debel, N.; Cercek, M.; Jensen, L.O.; Vavlukis, M.; Calmac, L.; Johnson, T.; Ferrer, G.R.; Ganyukov, V.; Wojakowski, W.; et al. Impact of SARS-CoV-2 Positivity on Clinical Outcome among STEMI Patients Undergoing Mechanical Reperfusion: Insights from the ISACS STEMI COVID 19 Registry. Atherosclerosis 2021, 332, 48–54. [Google Scholar] [CrossRef]
  41. Goel, A.; Malik, A.H.; Bandyopadhyay, D.; Isath, A.; Gupta, R.; Hajra, A.; Shrivastav, R.; Virani, S.S.; Fonarow, G.C.; Lavie, C.J.; et al. Impact of COVID-19 on Outcomes of Patients Hospitalized with STEMI: A Nationwide Propensity-Matched Analysis. Curr. Probl. Cardiol. 2023, 48, 101547. [Google Scholar] [CrossRef]
  42. Clinical Characteristics and Outcomes of Adults with a History of Heart Failure Hospitalized for COVID-19|Circulation: Heart Failure. Available online: https://www.ahajournals.org/doi/full/10.1161/CIRCHEARTFAILURE.121.008354 (accessed on 22 June 2023).
  43. Yonas, E.; Alwi, I.; Pranata, R.; Huang, I.; Lim, M.A.; Gutierrez, E.J.; Yamin, M.; Siswanto, B.B.; Virani, S.S. Effect of Heart Failure on the Outcome of COVID-19—A Meta Analysis and Systematic Review. Am. J. Emerg. Med. 2021, 46, 204–211. [Google Scholar] [CrossRef]
  44. Heart Failure in COVID-19 Patients: Prevalence, Incidence and Prognostic Implications—Rey-2020-European Journal of Heart Failure-Wiley Online Library. Available online: https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.1990 (accessed on 22 June 2023).
  45. Kubica, J.; Ostrowska, M.; Stolarek, W.; Kasprzak, M.; Grzelakowska, K.; Krys, J.; Kubica, A.; Adamski, P.; Podhajski, P.; Navarese, E.P.; et al. Impact of COVID-19 Pandemic on Acute Heart Failure Admissions and Mortality: A Multicentre Study (COV-HF-SIRIO 6 Study). ESC Heart Fail 2022, 9, 721–728. [Google Scholar] [CrossRef]
  46. Arutyunov, G.P.; Tarlovskaya, E.I.; Arutyunov, A.G.; Lopatin, Y.M. ACTIV Investigators Impact of Heart Failure on All-Cause Mortality in COVID-19: Findings from the Eurasian International Registry. ESC Heart Fail 2023, 10, 1013–1024. [Google Scholar] [CrossRef]
  47. Gu, H.; Cirillo, C.; Nabeebaccus, A.A.; Sun, Z.; Fang, L.; Xie, Y.; Demir, O.; Desai, N.; He, L.; Lü, Q.; et al. First-Phase Ejection Fraction, a Measure of Preclinical Heart Failure, Is Strongly Associated with Increased Mortality in Patients with COVID-19. Hypertension 2021, 77, 2014–2022. [Google Scholar] [CrossRef] [PubMed]
  48. Gupta, P.; Gupta, M.; KAtoch, N.; Garg, K.; Garg, B. A Systematic Review and Meta-Analysis of Diabetes Associated Mortality in Patients with COVID-19. Int. J. Endocrinol. Metab. 2021, 19, e113220. [Google Scholar] [CrossRef] [PubMed]
  49. Van Aerde, N.; Van den Berghe, G.; Wilmer, A.; Gosselink, R.; Hermans, G. COVID-19 Consortium Intensive Care Unit Acquired Muscle Weakness in COVID-19 Patients. Intensive Care Med. 2020, 46, 2083–2085. [Google Scholar] [CrossRef]
  50. Richardson, S.; Hirsch, J.S.; Narasimhan, M.; Crawford, J.M.; McGinn, T.; Davidson, K.W.; the Northwell COVID-19 Research Consortium; Barnaby, D.P.; Becker, L.B.; Chelico, J.D.; et al. Presenting Characteristics, Comorbidities, and Outcomes among 5700 Patients Hospitalized with COVID-19 in the New York City Area. JAMA 2020, 323, 2052–2059. [Google Scholar] [CrossRef]
  51. Kaziród-Wolski, K.; Sielski, J.; Sidło, J.; Januszek, R.; Siudak, Z. The Most Relevant Factors Affecting the Perioperative Death Rate in Patients with Acute Coronary Syndrome and COVID-19, Based on Annual Follow-Up in the ORPKI Registry. Biomedicines 2021, 9, 1813. [Google Scholar] [CrossRef]
  52. Comparison between COVID-19 Outcomes in the First 3 Waves of the Pandemic: A Reference Hospital Report. Available online: https://www.mp.pl/paim/issue/article/16286 (accessed on 27 August 2023).
  53. Oladunjoye, O.; Gallagher, M.; Wasser, T.; Oladunjoye, A.; Paladugu, S.; Donato, A. Mortality due to COVID-19 Infection: A Comparison of First and Second Waves. J. Community Hosp. Intern. Med. Perspect. 2021, 11, 747–752. [Google Scholar] [CrossRef]
  54. Gray, W.K.; Navaratnam, A.V.; Day, J.; Wendon, J.; Briggs, T.W.R. COVID-19 Hospital Activity and in-Hospital Mortality during the First and Second Waves of the Pandemic in England: An Observational Study. Thorax 2022, 77, 1113–1120. [Google Scholar] [CrossRef]
  55. Meschiari, M.; Cozzi-Lepri, A.; Tonelli, R.; Bacca, E.; Menozzi, M.; Franceschini, E.; Cuomo, G.; Bedini, A.; Volpi, S.; Milic, J.; et al. First and Second Waves among Hospitalised Patients with COVID-19 with Severe Pneumonia: A Comparison of 28-Day Mortality over the 1-Year Pandemic in a Tertiary University Hospital in Italy. BMJ Open 2022, 12, e054069. [Google Scholar] [CrossRef]
  56. Harbuwono, D.S.; Handayani, D.O.T.L.; Wahyuningsih, E.S.; Supraptowati, N.; Ananda; Kurniawan, F.; Wafa, S.; Kristanti, M.; Pantoro, N.I.; Sinto, R.; et al. Impact of Diabetes Mellitus on COVID-19 Clinical Symptoms and Mortality: Jakarta’s COVID-19 Epidemiological Registry. Prim. Care Diabetes 2022, 16, 65–68. [Google Scholar] [CrossRef]
  57. Shang, L.; Shao, M.; Guo, Q.; Shi, J.; Zhao, Y.; Xiaokereti, J.; Tang, B. Diabetes Mellitus Is Associated with Severe Infection and Mortality in Patients with COVID-19: A Systematic Review and Meta-Analysis. Arch. Med. Res. 2020, 51, 700–709. [Google Scholar] [CrossRef]
  58. Schmitt, V.H.; Hobohm, L.; Munzel, T.; Wenzel, P.; Gori, T.; Keller, K. Clinical Impact of Diabetes Mellitus in Patients Hospitalized for Myocardial Infarction. Eur. Heart J. 2020, 41, ehaa946.1506. [Google Scholar] [CrossRef]
  59. Ahmed, B.; Davis, H.T.; Laskey, W.K. In-Hospital Mortality Among Patients with Type 2 Diabetes Mellitus and Acute Myocardial Infarction: Results from the National Inpatient Sample, 2000–2010. J. Am. Heart Assoc. 2014, 3, e001090. [Google Scholar] [CrossRef] [PubMed]
  60. Salinas-Botrán, A.; Sanz-Cánovas, J.; Pérez-Somarriba, J.; Pérez-Belmonte, L.M.; Cobos-Palacios, L.; Rubio-Rivas, M.; de-Cossío-Tejido, S.; Ramos-Rincón, J.M.; Méndez-Bailón, M.; Gómez-Huelgas, R.; et al. Clinical characteristics and risk factors for mortality upon admission in patients with heart failure hospitalized due to COVID-19 in Spain. Rev. Clin. Esp. 2022, 222, 255–265. [Google Scholar] [CrossRef] [PubMed]
  61. Bhatt, A.S.; Jering, K.S.; Vaduganathan, M.; Claggett, B.L.; Cunningham, J.W.; Rosenthal, N.; Signorovitch, J.; Thune, J.J.; Vardeny, O.; Solomon, S.D. Clinical Outcomes in Patients with Heart Failure Hospitalized with COVID-19. JACC Heart Fail. 2021, 9, 65–73. [Google Scholar] [CrossRef]
  62. Sokolski, M.; Reszka, K.; Suchocki, T.; Adamik, B.; Doroszko, A.; Drobnik, J.; Gorka-Dynysiewicz, J.; Jedrzejczyk, M.; Kaliszewski, K.; Kilis-Pstrusinska, K.; et al. History of Heart Failure in Patients Hospitalized Due to COVID-19: Relevant Factor of In-Hospital Complications and All-Cause Mortality up to Six Months. J. Clin. Med. 2022, 11, 241. [Google Scholar] [CrossRef]
  63. Alvarez-Garcia, J.; Lee, S.; Gupta, A.; Cagliostro, M.; Joshi, A.A.; Rivas-Lasarte, M.; Contreras, J.; Mitter, S.S.; LaRocca, G.; Tlachi, P.; et al. Prognostic Impact of Prior Heart Failure in Patients Hospitalized with COVID-19. J. Am. Coll. Cardiol. 2020, 76, 2334–2348. [Google Scholar] [CrossRef]
Jcm 12 05899 g001
Figure 1. Study design. COVID-19: coronavirus disease 2019, MI: myocardial infarction.
Figure 1. Study design. COVID-19: coronavirus disease 2019, MI: myocardial infarction.
Jcm 12 05899 g001
Jcm 12 05899 g002
Figure 2. Comparison of overall in-hospital mortality in patients with COVID-19 vs. controls. COVID-19: coronavirus disease 2019.
Figure 2. Comparison of overall in-hospital mortality in patients with COVID-19 vs. controls. COVID-19: coronavirus disease 2019.
Jcm 12 05899 g002
Jcm 12 05899 g003
Figure 3. Mortality analysis in subgroups of patients. DM: diabetes mellitus; HF: heart failure; ICU: intensive care. (A) Comparison of in-hospital mortality in COVID-19 subgroups vs. control subgroups. (B) Kaplan–Meier analysis of 6-month overall mortality in the COVID-19 intensive care unit patient subgroup vs. COVID-19 non-intensive care unit patient subgroup.
Figure 3. Mortality analysis in subgroups of patients. DM: diabetes mellitus; HF: heart failure; ICU: intensive care. (A) Comparison of in-hospital mortality in COVID-19 subgroups vs. control subgroups. (B) Kaplan–Meier analysis of 6-month overall mortality in the COVID-19 intensive care unit patient subgroup vs. COVID-19 non-intensive care unit patient subgroup.
Jcm 12 05899 g003
Jcm 12 05899 g004
Figure 4. Kaplan–Meier analysis of 6-month overall mortality, comparing the COVID-19 group and controls. COVID-19: coronavirus disease 2019.
Figure 4. Kaplan–Meier analysis of 6-month overall mortality, comparing the COVID-19 group and controls. COVID-19: coronavirus disease 2019.
Jcm 12 05899 g004
Table 1. Basic clinical, procedural, and hospitalization characteristics of the COVID-19 group vs. controls.
Table 1. Basic clinical, procedural, and hospitalization characteristics of the COVID-19 group vs. controls.
COVID-19
(n = 129)		Control
(n = 129)		p
Clinical Characteristics
Men, n (%)92 (71.32%)92 (71.32%)
Women, n (%)37 (28.68%)37 (28.68%)
NSTEMI, n (%)66 (51.16%)66 (51.16%)
STEMI, n (%)63 (48.84%)63 (48.84%)
Age, years67 (61–75)67 (60–75)0.52
EF, %45 (35–50)45 (35–50)0.93
GFR, mL/min75.8 (53.5–94.5)80.14 (55.2–95.7)0.56
Diabetes, n (%)37 (28.68%)37 (28.68%)
Hypertension, n (%)86 (66.67%)100 (77.52%)0.05
Hyperlipidemia, n (%)56 (43.41%)76 (58.91%)0.01
Smoking, n (%)17 (13.18%)33 (25.58%)0.01
Peripheral arterial disease, n (%)2 (1.55%)13 (10.08%)0.004
Obesity, n (%)16 (12.4%)16 (12.4%)
Previous stroke, n (%)8 (6.2%)13 (10.08%)0.19
Atrial fibrillation, n (%)23 (17.83%)19 (14.73%)0.50
Myocardial infarction, n (%)25 (19.38%)29 (22.48%)0.54
Previous PTCA, n (%)20 (15.5%)26 (20.16%)0.33
Previous CABG, n (%)8 (6.2%)5 (3.88%)0.39
Procedural characteristics
Coronarography, n (%)125 (96.9%)128 (99.22%)0.18
OMT, n (%)4 (3.1%)1 (0.78%)0.18
CABG qualified, n (%)8 (6.2%)5 (3.88%)0.39
PTCA, n (%)107 (82.95%)112 (86.82%)0.85
Reached TIMI 3, n (%)91 (85.05%)105 (93.75%)0.02
POBA, n (%)(0%)(0%)
MVD, n (%)35 (27.13%)20 (15.5%)0.02
LM, n (%)5 (3.88%)6 (4.65%)0.76
LAD, n (%)41 (31.78%)49 (37.98%)0.30
D1, n (%)4 (3.1%)4 (3.1%)
CX, n (%)11 (8.53%)16 (12.4%)0.31
OM, n (%)4 (3.1%)9 (6.98%)0.15
RCA, n (%)25 (19.38%)29 (22.48%)0.54
PDA, n (%)0 (0%)2 (1.55%)0.16
IM, n (%)1 (0.78%)2 (1.55%)0.56
Bridge, n (%)2 (1.55%)3 (2.33%)0.65
Stent length, mm32 (20–51.5)25.5 (18–40)0.11
Multisteps, n (%)4 (3.1%)12 (9.3%)0.04
Hospitalization characteristics
Cardiogenic shock, n (%)18 (13.95%)8 (6.2%)0.04
Pulmonary edema, n (%)9 (6.98%)23 (17.83%)0.008
Respiratory failure, n (%)23 (17.83%)0 (0%)<0.001
Contrast-induced nephropathy, n (%)12 (9.3%)5 (3.88%)0.08
Stroke, n (%)1 (0.78%)0 (0%)0.32
Bleeding requiring transfusion, n (%)5 (3.88%)0 (0%)0.02
Hospitalization time (days)10 (4–14)4 (3–5)<0.001
Time to death (days)8 (3.25–13.75)16 (6–22)0.28
Transfer to another ward frequency, n (%)72 (55.81%)10 (7.75%)<0.001
CABG: coronary artery bypass graft; CX: circumflex artery; D1: diagonal branches of the left anterior descending artery; EF: ejection fraction; GFR: glomerular filtration rate; IM: intermediate artery; LAD: left anterior descending artery; LM: left main coronary artery; MVD: multivessel coronary artery disease; NSTEMI: non-ST-elevation myocardial infarction; OM: obtuse marginal artery; OMT: optimal medical therapy; PDA: posterior descending artery; POBA: balloon angioplasty; PTCA: percutaneous transluminal coronary angioplasty; RCA: right coronary artery; STEMI: ST-elevation myocardial infarction; TIMI3: thrombolysis in myocardial infarction.
Table 2. Cox univariable and multivariable regression analyses for predictors of all-cause mortality.
Table 2. Cox univariable and multivariable regression analyses for predictors of all-cause mortality.
Univariable Cox RegressionMultivariable Cox Regression
ParameterHR−95% CI+95% CIpHR−95% CI+95% CIp
COVID-197.451.7432.010.0079.102.1239.000.003
Acute respiratory failure with mechanical ventilation6.733.2913.78<0.0016.803.3213.94<0.001
Sex1.200.562.610.64
Diabetes1.700.853.390.13
GFR, mL/min0.990.981.000.076
EF, %0.970.940.990.040.960.930.990.013
Age, years1.010.981.040.40
MI type (STEMI vs. NSTEMI)1.290.642.580.47
COVID-19: coronavirus disease 2019; EF: ejection fraction; GFR: glomerular filtration rate; MI: myocardial infarction.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Hrycek, E.; Walawska-Hrycek, A.; Hamankiewicz, M.; Milewski, K.; Nowakowski, P.; Buszman, P.; Żurakowski, A. The Influence of SARS-CoV-2 Infection on Acute Myocardial Infarction Outcomes. J. Clin. Med. 2023, 12, 5899. https://doi.org/10.3390/jcm12185899

AMA Style

Hrycek E, Walawska-Hrycek A, Hamankiewicz M, Milewski K, Nowakowski P, Buszman P, Żurakowski A. The Influence of SARS-CoV-2 Infection on Acute Myocardial Infarction Outcomes. Journal of Clinical Medicine. 2023; 12(18):5899. https://doi.org/10.3390/jcm12185899

Chicago/Turabian Style

Hrycek, Eugeniusz, Anna Walawska-Hrycek, Maciej Hamankiewicz, Krzysztof Milewski, Przemysław Nowakowski, Piotr Buszman, and Aleksander Żurakowski. 2023. "The Influence of SARS-CoV-2 Infection on Acute Myocardial Infarction Outcomes" Journal of Clinical Medicine 12, no. 18: 5899. https://doi.org/10.3390/jcm12185899

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop