Impact of the COVID-19 Pandemic, Stratified by Transfer and COVID-19 Infection Status, on Inpatient Mortality in ST-Elevation Myocardial Infarction Patients, Using a Nationally Representative Database

Abstract

IntroductionThe coronavirus disease 2019 (COVID-19) pandemic has impacted various aspects of healthcare, including the management of ST-elevation myocardial infarction (STEMI) patients. Our study investigates the in-hospital outcomes and the impact of transfer and COVID-19 infection status on mortality in STEMI patients.MethodsWe conducted a retrospective cohort study to compare the inpatient outcomes of STEMI patients in 2020 with STEMI patients from 2016 to 2019 using the National Inpatient Sample database. We performed 1:1 greedy nearest neighbor matching and utilized logistic regression to compare mortality.ResultsIn our matched cohort, there was no difference in overall mortality between STEMI patients in 2020 and those from 2016 to 2019 (OR 1.00, 95% CI: 0.94-1.05; p = 0.87). When stratified by COVID-19 infection status, regularly admitted STEMI patients with concurrent COVID-19 infection in 2020 had 2.11 times higher odds of inpatient mortality compared to regularly admitted STEMI patients from 2016 to 2019 (OR 2.11, 95% CI: 1.55-2.87; p < 0.001). STEMI acute care transfers with concurrent COVID-19 infection in 2020 had 3.17 times higher odds of inpatient mortality than those from 2016 to 2019 (OR 3.17, 95% CI: 1.83-5.50; p < 0.001). STEMI non-acute care transfers with concurrent COVID-19 infection in 2020 had 5.13 times higher odds of inpatient mortality than those from 2016 to 2019 (OR 5.13, 95% CI: 1.87-14.06; p = 0.001).ConclusionThe COVID-19 pandemic exacerbated many longstanding disparities within our healthcare system. Moving forward, it is crucial to engage in further discussions addressing the national physician shortage, the patient transfer system and healthcare in underserved regions.