Increased mortality and worse cardiac outcome of acute myocardial infarction during the early COVID‐19 pandemic

Abstract

Aims This study aimed to evaluate the impact of coronavirus disease 2019 (Covid-19) outbreak on admissions for acute myocardial infarction (AMI) and related mortality, severity of presentation, major cardiac complications and outcome in a tertiarycare university hospital in Berlin, Germany. Methods and results In a single-centre cross-sectional observational study, we included 355 patients with AMI containing ST-elevation or non-ST-elevation myocardial infarction (STEMI or NSTEMI), admitted for emergency cardiac catheterization between January and April 2020 and the equivalent time in 2019. During the early phase of the Covid-19 pandemic (e-COV) in Berlin (March and April 2020), admissions for AMI halved compared with those in the pre-Covid-19 time (January and February 2020; pre-COV) and with those in the corresponding months in 2019. However, mortality for AMI increased substantially from 5.2% pre-COV to 17.7% (P < 0.05) during e-COV. Severity of presentation for AMI was more pronounced during e-COV [increased levels of cardiac enzymes, reduced left ventricular ejection fraction (LVEF), an increase in the need of inotropic support by 25% (P < 0.01)], while patients' demographic and angiographic characteristics did not differ between pre-COV and e-COV. Time from symptom onset to first medical contact was prolonged in all AMI during e-COV (presentation > 72 h +21% in STEMI, p = 0.04 and presentation > 72 h in NSTEMI +22%, p = 0.02). Door to balloon time was similar in STEMI patients, while time from first medical contact to revascularization was significantly delayed in NSTEMI patients (p = 0.02). Major cardiac complications after AMI occurred significantly more often, and cardiac recovery was worse in e-COV than in pre-COV, demonstrated by a significantly lower LVEF (39 ± 16 vs. 46 ± 16, p < 0.05) at hospital discharge and substantially higher NTproBNP levels. Conclusions The Covid-19 outbreak affects hospital admissions for acute coronary syndromes. During the first phase of the pandemia, significantly less patients with AMI were admitted, but those admitted presented with a more severe phenotype and had a higher mortality, more complications, and a worse short-term outcome. Therefore, our data indicate that Covid-19 had relevant impact on non-infectious disease states, such as acute coronary syndromes.

Global burden of acute myocardial injury associated with COVID-19: A systematic review, meta-analysis, and meta-regression

“…Different works of the literature showed that there is a strong correlation between acute myocardial Injury and COVID-19 infection. New studies are being published from around the globe but the link between acute myocardial injury and COVID-19, the prevalence, reliability of diagnostic modalities, independent predictors, and clinical outcomes are still uncertain and a topic of debate [ 22 , 24 , 26 , [32] , [33] , [34] , [35] , 41 , 44 , 50 , 53 , [57] , [58] , [59] , 62 , 76 , [81] , [82] , [83] , [84] , [85] ].…”

“…Different studies were conducted to investigate the predicting ability of cardiac biomarkers on in-hospital mortality [ 44 , [49] , [50] , [51] , [52] , [53] ]. But cardiac troponin showed consistent sensitivity and Specificity in different works of literature to predict in-hospital mortality [ 44 , 52 , 53 ].…”

“…The incidence of myocardial injury associated with COVID-19 is very variable which ranges from 0.3 to 89 %. This variation is assumed to be linked to diagnostic biomarkers, presence of comorbidities, critical illness, and use of medications that are presumed to have high cardiac morbidity and mortality [ 30 , 31 , 34 , 40 , 46 , 50 , [54] , [55] , [56] , [57] , [58] ].…”

Covid and Cardiovascular Diseases: Direct and Indirect Damages and Future Perspective

“…Data collected from Hong Kong showed an extension in median time from symptoms onset to first medical contact from 82.5 to 318 min, and an increase in median door-to-balloon time from 84.5 to 110 min [ 48 ]. Another German study revealed a 21% increase in delayed presentation (defined as > 72 h from symptoms onset) in ACS patients compared to the pre-SARS-CoV-2 pandemic [ 49 ]. As well known, ischemia duration is one of the major determinant of subsequent complication in ACS and is directly related to short- and long-term survival [ 50 ].…”

“…Beside this, also lack of or delayed access to reperfusion treatment lead to an increase in short-term ACS complications. In fact, many studies [ 49 , 51 ] described a significant growth in mechanical complications, left ventricular systolic dysfunction, intraventricular thrombus and a higher rate of subsequent CV events (cardiac arrest, cardiogenic shock, and life-threatening arrhythmias).…”