Association Between COVID-19 Diagnosis and In-Hospital Mortality in Patients Hospitalized With ST-Segment Elevation Myocardial Infarction

Saad, Marwan; Kennedy, Kevin; Imran, Hafiz; Louis, David; Shippey, Ernie; Poppas, Athena; Wood, Kenneth E.; Abbott, J. Dawn; Aronow, Herbert D.

doi:10.1001/jama.2021.18890

Cited by 82 publications

(95 citation statements)

References 35 publications

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“…Interestingly, aside from increased troponin and D-dimer levels, the remaining laboratory findings were similar between patients who tested positive for COVID and those who tested negative 49 . A retrospective study of over 80,000 patients compared out-of-hospital or in-hospital STEMI in patients with and without COVID-19 50 . Results were significant for increased in-hospital mortality in patients with a concomitant diagnosis of COVID-19 compared to patients without COVID-19.…”

Section: Cardiac Manifestations Of Covid-19mentioning

confidence: 99%

COVID-19 Cardiovascular Connection: A Review of Cardiac Manifestations in COVID-19 Infection and Treatment Modalities

Maitz

Parfianowicz

Vojtek

et al. 2023

Current Problems in Cardiology

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Section: Cardiac Manifestations Of Covid-19mentioning

confidence: 99%

COVID-19 Cardiovascular Connection: A Review of Cardiac Manifestations in COVID-19 Infection and Treatment Modalities

Maitz

Parfianowicz

Vojtek

et al. 2023

Current Problems in Cardiology

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“…Additionally, the composite outcome of death, stroke, or MI and the composite outcome of death or stroke were both more frequently observed in the in- and out-of-hospital STEMI cohorts 20 . Reassuringly, the mortality rate among STEMI patients without COVID-19 were similar during the pandemic when compared to 2019, suggesting that alterations in systems of care were not to blame for the increased mortality 20 .…”

Section: Cardiovascular Manifestations Of Covidmentioning

confidence: 93%

“…In a retrospective analysis of 28,189 STEMI patients in China between December 27, 2019 – February 20, 2020, a higher likelihood of in-hospital mortality [OR 1.21; (95% CI: 1.07 – 1.37); p = 0.003] was observed in those with versus without COVID-19 21 . Similarly, in a retrospective cohort study of 80,449 U.S. patients from the Vizient Clinical Database admitted between January 1, 2019 and December 31, 2020, rates of in-hospital mortality among patients propensity matched on the likelihood of COVID-19 were higher in those who were COVID-19 positive than COVID-19 negative both for out-of-hospital (15.2% vs 11.2%, p = 0.007) and in-hospital STEMI (78.5% vs 46.1%; p < 0.001) 20 . Additionally, the composite outcome of death, stroke, or MI and the composite outcome of death or stroke were both more frequently observed in the in- and out-of-hospital STEMI cohorts 20 .…”

Section: Cardiovascular Manifestations Of Covidmentioning

confidence: 96%

“…Similarly, in a retrospective cohort study of 80,449 U.S. patients from the Vizient Clinical Database admitted between January 1, 2019 and December 31, 2020, rates of in-hospital mortality among patients propensity matched on the likelihood of COVID-19 were higher in those who were COVID-19 positive than COVID-19 negative both for out-of-hospital (15.2% vs 11.2%, p = 0.007) and in-hospital STEMI (78.5% vs 46.1%; p < 0.001) 20 . Additionally, the composite outcome of death, stroke, or MI and the composite outcome of death or stroke were both more frequently observed in the in- and out-of-hospital STEMI cohorts 20 . Reassuringly, the mortality rate among STEMI patients without COVID-19 were similar during the pandemic when compared to 2019, suggesting that alterations in systems of care were not to blame for the increased mortality 20 .…”

Section: Cardiovascular Manifestations Of Covidmentioning

confidence: 96%

“…While primary PCI remained the gold standard for treatment of ACS, strained hospital resources, perceived risk to catheterization lab personnel, and system delays negatively impacting door-to-balloon time prompted conversations about the use of fibrinolytics for patients presenting with STEMI 18 , 19 . In a large observational study evaluating in-hospital mortality in patients hospitalized with STEMI, fibrinolytics were used more frequently as reperfusion therapy in patients with COVID-19 than in patients without COVID-19 (0.2% vs 1.9%; p < 0.001), but their use was still much less common than that of primary percutaneous coronary intervention 20 .…”

Section: Cardiovascular Manifestations Of Covidmentioning

confidence: 99%

See 2 more Smart Citations

The Cardiovascular Manifestations of COVID-19

et al. 2022

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Myocardial Infarction During the COVID-19 Pandemic

Fanaroff

García

Giri

2021

JAMA

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Early during the COVID-19 pandemic, it was recognized that infection with SARS-CoV-2 was associated with an increased risk of both arterial and venous thrombotic complications. This association is strongest for venous thromboembolic disease, but the risk of myocardial infarction (MI) is approximately doubled in the 7 days after COVID-19 diagnosis. 1 Multiple studies have suggested worse outcomes in patients with COVID-19 and MI, 2,3 with direct effects of the virus on endothelial cells, increased propensity for vascular thrombosis, and deficient care delivery all mechanistically implicated. 4 The study by Saad et al 5 in this issue of JAMA reexamines these findings in the largest cohort yet described. Using the Vizient Clinical Database, an administrative database of more than 700 US academic hospitals and affiliates, the authors described in-hospital outcomes for patients with COVID-19 and ST-segment elevation MI (STEMI). Propensity score matching was used to compare patients with COVID-19 and STEMI with 2 separate control groups: patients without COVID-19 hospitalized with STEMI in 2020 and patients hospitalized with STEMI in 2019 before the onset of the pandemic. By comparing patients who were cared for under the same system constraints, the first comparison attempted to isolate the association between concomitant COVID-19 and STEMI outcomes, whereas the second comparison evaluated the association of both COVID-19 infection and care delivery before and after the COVID-19 pandemic with STEMI outcomes.The authors found that among 36 309 patients with outof-hospital STEMI admitted to more than 500 primary percutaneous coronary intervention (PCI)-capable hospitals in 2020, a total of 565 had concomitant COVID-19; 359 of 1937 patients with in-hospital STEMI had concomitant COVID-19. After adjusting for patient and hospital factors in the propensity score-matched analysis, 15% of patients with COVID-19 and out-of-hospital STEMI died compared with 11% of patients without COVID-19 with STEMI (odds ratio, 1.43 [95% CI, 1.10-1.86]); 77% of patients with COVID-19 and in-hospital STEMI died compared with 44% of patients without 4.11 [95% CI,). These results were similar when comparing patients with COVID-19 and STEMI vs patients without COVID-19 and STEMI from 2020 or patients with STEMI from 2019 in the pre-COVID-19 era.The study by Saad et al 5 represents an important effort to better describe MI outcomes during the pandemic, although several limitations challenge the interpretation of these data. First, the administrative database used in this study lacks granular clinical information. Although the

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Association Between COVID-19 Diagnosis and In-Hospital Mortality in Patients Hospitalized With ST-Segment Elevation Myocardial Infarction

Cited by 82 publications

References 35 publications

COVID-19 Cardiovascular Connection: A Review of Cardiac Manifestations in COVID-19 Infection and Treatment Modalities

COVID-19 Cardiovascular Connection: A Review of Cardiac Manifestations in COVID-19 Infection and Treatment Modalities

The Cardiovascular Manifestations of COVID-19

Myocardial Infarction During the COVID-19 Pandemic

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