Acute myocardial infarction during late COVID-19 era: patient characteristics, presentation and outcomes

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Submitted: December 3, 2022
Accepted: December 15, 2022
Published: January 13, 2023
Abstract Views: 1302
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Authors

COVID-19 pandemic has unquestionably influenced care of acute myocardial infarction (AMI). Still, its impact on patients (pts) characteristics, presentation, treatment, and outcomes remains not well established in late pandemic times. To address this issue, we performed a prospective study of type-1 AMI patients admitted in a tertiary care hospital. Pts were enrolled during 6-months in 2019 [n=122; pre-COVID-19 (PC) group] and in 2021 [n=196; late-COVID-19 (C) group]. Data was based on pts interview and review of medical records. Age and gender distribution, as well as ST/non-ST-elevation myocardial infarction (STEMI/NSTEMI) proportion and access to coronariography and revascularization were similar between groups. Group C patients presented more pre-existing established cardiovascular disease (CVD) (43% vs 30%; p=0.03); more frequent description of typical chest pain (94% vs 84%; p=0,002); higher levels of pain intensity, in a 0-10 scale (8±2 vs 7±2; p=0.02); higher frequencies of AMI complications (27% vs 15%; p=0.01) and worse Killip (K) class evolution (K≥2 in 22% C vs13% PC patients; p=0.05). In conclusion, late pandemic AMI patients presented worse in-hospital outcomes in our study, though pre-hospital and hospital care were comparable to pre-pandemic times. COVID patients had a higher burden of pre-existing established CVD and a more typical and intense symptom presentation. Therefore, it can be hypothesized that "sicker" patients continued to look for help when presenting AMI symptoms, while "less sick" patients and the ones with less typical and intense symptoms possibly avoided contact with health care services during late pandemic period.

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Citations

Grave C, Gabet A, Puymirat E, et al. Myocardial infarction throughout 1 year of the COVID-19 pandemic: French nationwide study of hospitalization rates, prognosis and 90-day mortality rates. Arch Cardiovasc Dis 2021;114:768-80. DOI: https://doi.org/10.1016/j.acvd.2021.10.008
Mefford MT, An J, Gupta N, et al. Rates of acute myocardial infarction during the COVID-19 pandemic. Perm J 2021;25:074. DOI: https://doi.org/10.7812/TPP/21.074
Pereira H, Naber C, Wallace S, et al. Stent-Save a Life international survey on the practice of primary percutaneous coronary intervention during the COVID-19 pandemic. Rev Portug Cardiol 2022;41:221-7. DOI: https://doi.org/10.1093/eurheartj/ehab724.1240
Jasani G, Alemayehu T, Chizmar T, Wilson L. Changes in EMS utilization in the state of Maryland during the first 6 months of the COVID-19 pandemic. Am J Disaster Med 2022;17:41-8. DOI: https://doi.org/10.5055/ajdm.2022.0418
Burger AL, Kaufmann CC, Jäger B, et al. Direct cardiovascular complications and indirect collateral damage during the COVID-19 pandemic : A review. Wien Klin Wochenschr 2021;133:1289-97. DOI: https://doi.org/10.1007/s00508-021-01956-2
Azul Freitas A, Baptista R, Gonçalves V, et al. Impact of SARS-CoV-2 pandemic on ST-elevation myocardial infarction admissions and outcomes in a Portuguese primary percutaneous coronary intervention center: Preliminary Data. Rev Portug Cardiol 2022;41:465-71. DOI: https://doi.org/10.1016/j.repc.2020.10.012
Calvão J, Amador AF, Costa CMd, et al. The impact of the COVID-19 pandemic on acute coronary syndrome admissions to a tertiary care hospital in Portugal. Rev Portug Cardiol 2022;41:147-52. DOI: https://doi.org/10.1016/j.repc.2021.01.007
Clodfelder C, Cooper S, Edwards J, et al. Delayed care in myocardial infarction and ischemic stroke patients during the COVID-19 pandemic. Am J Emerg Med 2022;54:326.e1-4. DOI: https://doi.org/10.1016/j.ajem.2021.10.023
Guddeti RR, Yildiz M, Nayak KR, et al. Impact of COVID-19 on acute myocardial infarction care. Cardiol Clin 2022;40:345-53. DOI: https://doi.org/10.1016/j.ccl.2022.03.004
D'Abramo M, Saltarocchi S, Vignaroli W, et al. Increased incidence of postmyocardial infarction ventricular septal defects during Covid-19 pandemic: A case series. J Card Surg 2022;37:1759-63. DOI: https://doi.org/10.1111/jocs.16430
Oliveira L, Campante Teles R, Machado C, et al. Worrisome trends of ST-elevation myocardial infarction during the Covid-19 pandemic: Data from Portuguese centers. Rev Portug Cardiol 2022;41:465-71. DOI: https://doi.org/10.1016/j.repc.2021.03.012
Simoni L, Alimehmeti I, Gina M, et al. Hospitalizations and in-hospital outcomes in patients with ST-elevation myocardial infarction during the coronavirus disease 2019 pandemic: The Albanian experience. Anatol J Cardiol 2022;26:118-26. DOI: https://doi.org/10.5152/AnatolJCardiol.2021.486
Malhi N, Moghaddam N, Hosseini F, et al. Care and outcomes of ST-segment elevation myocardial infarction across multiple COVID-19 waves. Can J Cardiol 2022;38:783-91. DOI: https://doi.org/10.1016/j.cjca.2022.01.033
Banfield WH, Elghawy O, Dewanjee A, Brady WJ. Impact of COVID-19 on emergency department management of stroke and STEMI. A narrative review. Am J Emerg Med 2022;57:91-7. DOI: https://doi.org/10.1016/j.ajem.2022.04.033
Ryu S, Kim D, Jung LY, et al. Decreased door-to-balloon time in patients with ST-segment elevation myocardial infarction during the early COVID-19 pandemic in South Korea: An observational study. Medicine (Baltimore) 2022;101:e29596. DOI: https://doi.org/10.1097/MD.0000000000029596
Gong X, Zhou L, Dong T, et al. Impact of COVID-19 pandemic on STEMI undergoing primary PCI treatment in Beijing, China. Am J Emerg Med 2022;53:68-72. DOI: https://doi.org/10.1016/j.ajem.2021.11.034

Ethics Approval

The study was approved by the Ethics Committee of “Centro Hospitalar Universitário de São João / Faculdade de Medicina da Universidade do Porto” on September 21, 2021 (reference number 290/21)

How to Cite

Marques, Catarina Amaral, André Cabrita, Paulo Araújo, Tânia Proença, Ricardo Pinto, Miguel Carvalho, Catarina Costa, Ana Amador, João Calvão, and Cristina Cruz. 2023. “Acute Myocardial Infarction During Late COVID-19 Era: Patient Characteristics, Presentation and Outcomes”. Monaldi Archives for Chest Disease 93 (4). https://doi.org/10.4081/monaldi.2023.2502.