1
|
De Luca G, Algowhary M, Uguz B, Oliveira DC, Ganyukov V, Zimbakov Z, Cercek M, Okkels Jensen L, Loh PH, Calmac L, Roura I Ferrer G, Quadros A, Milewski M, Scotto Di Uccio F, von Birgelen C, Versaci F, Ten Berg J, Casella G, Wong Sung Lung A, Kala P, Díez Gil JL, Carrillo X, Dirksen M, Becerra-Munoz VM, Kang-Yin Lee M, Juzar DA, de Moura Joaquim R, De Simone C, Milicic D, Davlouros P, Bakraceski N, Zilio F, Donazzan L, Kraaijeveld A, Galasso G, Arpad L, Marinucci L, Guiducci V, Menichelli M, Scoccia A, Yamac AH, Ugur Mert K, Flores Rios X, Kovarnik T, Kidawa M, Moreu J, Flavien V, Fabris E, Lozano Martínez-Luengas I, Boccalatte M, Bosa Ojeda F, Arellano-Serrano C, Caiazzo G, Cirrincione G, Kao HL, Sanchis Forés J, Vignali L, Pereira H, Manzo-Silbermann S, Ordoñez S, Arat Özkan A, Scheller B, Lehtola H, Teles R, Mantis C, Antti Y, Brum Silveira JA, Bessonov I, Zoni R, Savonitto S, Kochiadakis G, Alexopoulos D, Uribe CE, Kanakakis J, Faurie B, Gabrielli G, Gutierrez Barrios A, Bachini JP, Rocha A, Tam FCC, Rodriguez A, Lukito AA, Bellemain-Appaix A, Pessah G, Cortese G, Parodi G, Burgadha MA, Kedhi E, Lamelas P, Suryapranata H, Nardin M, Verdoia M. SARS-CoV-2 Positivity, Stent Thrombosis, and 30-day Mortality in STEMI Patients Undergoing Mechanical Reperfusion. Angiology 2023; 74:987-996. [PMID: 36222189 DOI: 10.1177/00033197221129351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
SARS-Cov-2 has been suggested to promote thrombotic complications and higher mortality. The aim of the present study was to evaluate the impact of SARS-CoV-2 positivity on in-hospital outcome and 30-day mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) enrolled in the International Survey on Acute Coronary Syndromes ST-segment elevation Myocardial Infarction (ISACS-STEMI COVID-19 registry. The 109 SARS-CoV-2 positive patients were compared with 2005 SARS-CoV-2 negative patients. Positive patients were older (P = .002), less often active smokers (P = .002), and hypercholesterolemic (P = .006), they presented more often later than 12 h (P = .037), more often to the hub and were more often in cardiogenic shock (P = .02), or requiring rescue percutaneous coronary intervention after failed thrombolysis (P < .0001). Lower postprocedural Thrombolysis in Myocardial Infarction 3 flow (P = .029) and more thrombectomy (P = .046) were observed. SARS-CoV-2 was associated with a significantly higher in-hospital mortality (25.7 vs 7%, adjusted Odds Ratio (OR) [95% Confidence Interval] = 3.2 [1.71-5.99], P < .001) in-hospital definite in-stent thrombosis (6.4 vs 1.1%, adjusted Odds Ratio [95% CI] = 6.26 [2.41-16.25], P < .001) and 30-day mortality (34.4 vs 8.5%, adjusted Hazard Ratio [95% CI] = 2.16 [1.45-3.23], P < .001), confirming that SARS-CoV-2 positivity is associated with impaired reperfusion, with negative prognostic consequences.
Collapse
Affiliation(s)
- Giuseppe De Luca
- Division of Clinical and Experimental Cardiology, AOU Sassari, Sassari, Italy Division of Cardiology, Ospedale Nuovo Galeazzi, Milan, Italy
| | - Magdy Algowhary
- Division of Cardiology, Assiut University Heart Hospital, Assiut University, Asyut, Egypt
| | - Berat Uguz
- Division of Cardiology, Bursa City Hospital, Bursa, Turkey
| | - Dinaldo C Oliveira
- Pronto de Socorro Cardiologico Prof. Luis Tavares, Centro PROCAPE, Federal University of Pernambuco, Recife, Brasil
| | - Vladimir Ganyukov
- Department of Heart and Vascular Surgery, State Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Zan Zimbakov
- University Clinic for Cardiology, Medical Faculty, Ss' Cyril and Methodius University, Skopje, North Macedonia
| | - Miha Cercek
- Centre for Intensive Internal Medicine, University Medical Centre, Ljubljana, Slovenia
| | | | - Poay Huan Loh
- Department of Cardiology, National University Hospital, Singapore
| | | | - Gerard Roura I Ferrer
- Interventional Cardiology Unit, Heart Disease Institute. Hospital Universitari de Bellvitge, Spain
| | | | - Marek Milewski
- Division of Cardiology, Medical University of Silezia, Katowice, Poland
| | | | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, The Netherlands
- Technical Medical Centre, Health Technologies and Services Research, University of Twente, Enschede, Netherlands
| | | | - Jurrien Ten Berg
- Division of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Gianni Casella
- Division of Cardiology, Ospedale Maggiore Bologna, Italy
| | | | - Petr Kala
- University Hospital Brno, Medical Faculty of Masaryk University Brno, Czech Republic
| | | | | | - Maurits Dirksen
- Division of Cardiology, Northwest Clinics Alkmaar, The Netherlands
| | | | - Michael Kang-Yin Lee
- Department of Cardiology, Queen Elizabeth Hospital, University of Hong Kong, Hong Kong
| | - Dafsah Arifa Juzar
- Department of Cardiology and Vascular Medicine, University of Indonesia National Cardiovascular Center "Harapan Kita", Jakarta
| | | | - Ciro De Simone
- Division of Cardiology, Clinica Villa Dei Fiori, Acerra, Italy
| | - Davor Milicic
- Department of Cardiology, University Hospital Centre, University of Zagreb, Zagreb, Croatia
| | - Periklis Davlouros
- Invasive Cardiology and Congenital Heart Disease, Patras University Hospital, Patras, Greece
| | | | - Filippo Zilio
- Division of Cardiology, Ospedale Santa Chiara di Trento, Italy
| | - Luca Donazzan
- Division of Cardiology, Ospedale "S. Maurizio", Bolzano, Italy
| | | | - Gennaro Galasso
- Division of Cardiology, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Lux Arpad
- Maastricht University Medical Center, Utrecht, Netherlands
| | - Lucia Marinucci
- Division of Cardiology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Pesaro, Italy
| | | | | | | | - Aylin Hatice Yamac
- Department of Cardiology, Hospital Bezmialem Vakıf University İstanbul, Istanbul, Turkey
| | - Kadir Ugur Mert
- Division of Cardiology, Eskisehir Osmangazi University, Faculty of Medicine, Eskisehir, Turkey
| | | | | | - Michal Kidawa
- Central Hospital of Medical University of Lodz, Poland
| | - Josè Moreu
- Division of Cardiology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Vincent Flavien
- Division of Cardiology, Center Hospitalier Universitaire de Lille, Lille, France
| | - Enrico Fabris
- Azienda Ospedaliero - Universitaria Ospedali Riuniti Trieste, Italy
| | | | - Marco Boccalatte
- Division of Cardiology, Ospedale Santa Maria Delle Grazie, Pozzuoli, Italy
| | - Francisco Bosa Ojeda
- Division of Cardiology, Hospital Universitario de Canarias, Santa Cruz de Tenerife
| | | | | | | | - Hsien-Li Kao
- Cardiology Division, Department of Internal Medicine, National Taiwan University Hospital, Tapei, Taiwan
| | - Juan Sanchis Forés
- Division of Cardiology, Hospital Clinico Universitario de Valencia, Spain
| | - Luigi Vignali
- Interventional Cardiology Unit, Azienda Ospedaliera Sanitaria, Parma, Italy
| | - Helder Pereira
- Hospital Garcia de Orta, Cardiology Department, Pragal, Almada, Portugal
| | | | - Santiago Ordoñez
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Alev Arat Özkan
- Cardiology Institute, Instanbul University, Instanbul, Turkey
| | - Bruno Scheller
- Division of Cardiology, Clinical and Experimental Interventional Cardiology, University of Saarland, Germany
| | - Heidi Lehtola
- Division of Cardiology, Oulu University Hospital, Finland
| | - Rui Teles
- Division of Cardiology, Hospital de Santa Cruz, CHLO - Nova Medical School, CEDOC, Lisbon, Portugal
| | - Christos Mantis
- Division of Cardiology, Konstantopoulion Hospital, Athens, Greece
| | | | | | | | - Rodrigo Zoni
- Department of Teaching and Research, Instituto de Cardiología de Corrientes "Juana F. Cabral", Argentina
| | | | | | | | - Carlos E Uribe
- Carlos E Uribe, Division of Cardiology, Universidad UPB, Universidad CES, Medellin, Colombia
| | - John Kanakakis
- Division of Cardiology, Alexandra Hospital, Athens, Greece
| | - Benjamin Faurie
- Division of Cardiology, Groupe Hospitalier Mutualiste de Grenoble, France
| | - Gabriele Gabrielli
- Interventional Cardiology Unit, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | | | | | - Alex Rocha
- Department of Cardiology and Cardiovascular Interventions, Instituto Nacional de Cirugía Cardíaca, Montevideo, Uruguay
| | | | | | - Antonia Anna Lukito
- Cardiovascular Department Pelita Harapan University/Heart Center Siloam Lippo Village Hospital, Tangerang, Banten, Indonesia
| | | | - Gustavo Pessah
- Division of Cardiology, Hospiatl Cordoba, Cordoba, Argentina
| | | | - Guido Parodi
- Division of Cardiology, Ospedale di Lavagna, Italy
| | | | - Elvin Kedhi
- Division of Cardiology, Hopital Erasmus, Universitè Libre de Bruxelles, Belgium
| | | | - Harry Suryapranata
- Division of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Matteo Nardin
- Department of Internal Medicine, Ospedale Riuniti, Brescia, Italy
| | - Monica Verdoia
- Division of Cardiology, Ospedale Degli Infermi, ASL Biella, Italy
| |
Collapse
|
2
|
Ho HV, Patel H, Ahmed M, Eddib A, Oyesanmi O, Modi F, Sorresso D, Mhaskar R, Phrathep D. A Retrospective Cohort Study Assessing the Impact of Statin Therapy on Hospital Length of Stay and Inpatient Mortality in COVID-19 Patients. HCA HEALTHCARE JOURNAL OF MEDICINE 2023; 4:369-375. [PMID: 37969853 PMCID: PMC10635693 DOI: 10.36518/2689-0216.1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Background Coronaviruses, known for their crown-like appearance, cause mild gastrointestinal and respiratory diseases. Some cause outbreaks of respiratory diseases, most recently, SARS-CoV-2, the coronavirus disease 2019 (COVID-19). Individuals with COVID-19 are reported to be in both arterial and venous prothrombotic states. In addition to a lipid-lowering effect, statin also has an anti-inflammatory effect, which addresses one of the underlying causes of thrombosis. An in-silico study revealed that statins could directly interact with the main protease enzyme of SARS-CoV-2 and prevent infectivity. Due to these pleiotropic properties, statins may positively impact the outcome of hospitalized patients with COVID-19 infections. Methods A total of 26 445 acute COVID-19-infected patients were included in this study. Patients were stratified based on home statin use status: no statins, high-intensity statins (atorvastatin 40-80 mg daily and rosuvastatin 20-40 mg daily), and low-to-moderate intensity statins (all other statins). A multivariate generalized linear model and logistic regression were used to predict the hospital length of stay and inpatient mortality, respectively. Results The hospital length of stay was compared between low-intensity and high-intensity statin use against no statin therapy. The length of stay was 3.88 days (95% CI, 3.56-4.20; P < .0001) longer among patients with low-dose statin therapy compared to patients without. The length of stay was 4.77 days (95% CI, 4.42-5.13; P <.0001) longer among patients with high-intensity statin therapy than those without. The odds of in-hospital mortality decreased by 24% (OR, 0.76; 95% CI, 0.76-0.97) among those with high-dose statin therapy compared to patients without (P = .02). There was no statistical significance between the low-dose statin group and the no statin group for inpatient mortality. Conclusion Hospitalized COVID-19 patients on statin therapy, regardless of intensity, are more likely to have a longer length of stay. There may be a mortality benefit in using high-intensity statin in acute COVID-19-infected patients. The results of this study are insufficient to recommend statin therapy for inpatient COVID-19 treatment. However, patients with significant cardiovascular comorbidities, where statins are indicated, should be on these medications, especially amidst the COVID-19 pandemic. Randomized controlled trials are needed to assess the potential in-hospital benefit of statin therapy on COVID-19 patients.
Collapse
Affiliation(s)
- Huy V Ho
- HCA Healthcare/USF Morsani College of Medicine Graduate Medical Education
- HCA Florida Citrus Hospital, Inverness, FL
| | - Hamish Patel
- HCA Healthcare/USF Morsani College of Medicine Graduate Medical Education
- HCA Florida Bayonet Point Hospital, Hudson, FL
| | - Mohammed Ahmed
- HCA Healthcare/USF Morsani College of Medicine Graduate Medical Education
- HCA Florida Citrus Hospital, Inverness, FL
| | - Ahmed Eddib
- HCA Healthcare/USF Morsani College of Medicine Graduate Medical Education
- HCA Florida Citrus Hospital, Inverness, FL
| | - Olugbenga Oyesanmi
- HCA Healthcare/USF Morsani College of Medicine Graduate Medical Education
| | - Fagunkumar Modi
- HCA Healthcare/USF Morsani College of Medicine Graduate Medical Education
- HCA Florida Citrus Hospital, Inverness, FL
| | - Domenick Sorresso
- HCA Healthcare/USF Morsani College of Medicine Graduate Medical Education
- HCA Florida Bayonet Point Hospital, Hudson, FL
| | - Rahul Mhaskar
- Office of Research, Innovation and Scholarly Endeavors, University of South Florida College of Medicine, Tampa, FL
| | | |
Collapse
|
3
|
Koskinas KC, Twerenbold R, Carballo D, Matter CM, Cook S, Heg D, Frenk A, Windecker S, Osswald S, Lüscher TF, Mach F. Effects of SARS-COV-2 infection on outcomes in patients hospitalized for acute cardiac conditions. A prospective, multicenter cohort study (Swiss Cardiovascular SARS-CoV-2 Consortium). Front Cardiovasc Med 2023; 10:1203427. [PMID: 37900573 PMCID: PMC10613056 DOI: 10.3389/fcvm.2023.1203427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Background Although the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) causing coronavirus disease 2019 (COVID-19) primarily affects the respiratory system, the disease entity has been associated with cardiovascular complications. This study sought to assess the effect of concomitant SARS-COV-2 infection on clinical outcomes of patients hospitalized primarily for acute cardiac conditions on cardiology wards in Switzerland. Methods In this prospective, observational study conducted in 5 Swiss cardiology centers during the COVID-19 pandemic, patients hospitalized due to acute cardiac conditions underwent a reverse-transcriptase polymerase chain reaction test at the time of admission and were categorized as SARS-COV-2 positive (cases) or negative (controls). Patients hospitalized on cardiology wards underwent treatment for the principal acute cardiac condition according to local practice. Clinical outcomes were recorded in-hospital, at 30 days, and after 1 year and compared between cases and controls. To adjust for imbalanced baseline characteristics, a subgroup of patients derived by propensity matching was analyzed. Results Between March 2020 and February 2022, 538 patients were enrolled including 122 cases and 416 controls. Mean age was 68.0 ± 14.7 years, and 75% were men. Compared with controls, SARS-COV-2-positive patients more commonly presented with acute heart failure (35% vs. 17%) or major arrhythmia (31% vs. 9%), but less commonly with acute coronary syndrome (26% vs. 53%) or severe aortic stenosis (4% vs. 18%). Mortality was significantly higher in cases vs. controls in-hospital (16% vs. 1%), at 30 days (19.0% vs. 2.2%), and at 1 year (28.7% vs. 7.6%: p < 0.001 for all); this was driven primarily (up to 30 days) and exclusively (at one-year follow-up) by higher non-cardiovascular mortality, and was accompanied by a greater incidence of worsening renal function in cases vs. controls. These findings were maintained in a propensity-matched subgroup of 186 patients (93 cases and 93 controls) with balanced clinical presentation and baseline characteristics. Conclusions In this observational study of patients hospitalized for acute cardiac conditions, SARS-COV-2 infection at index hospitalization was associated with markedly higher all-cause and non-cardiovascular mortality throughout one-year follow-up. These findings highlight the need for effective, multifaceted management of both cardiac and non-cardiac morbidities and prolonged surveillance in patients with acute cardiac conditions complicated by SARS-COV-2 infection.
Collapse
Affiliation(s)
| | - Raphael Twerenbold
- Department of Cardiology, Basel University Hospital, Basel, Switzerland
- University Center of Cardiovascular Science & Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK) Partner Site Hamburg–Kiel–Lübeck, Hamburg, Germany
| | - David Carballo
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | | | - Stephane Cook
- Department of Cardiology, Fribourg Canton Hospital, Fribourg, Switzerland
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | - Andre Frenk
- Department of Cardiology, Bern University Hospital Inselspital, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital Inselspital, Bern, Switzerland
| | - Stefan Osswald
- Department of Cardiology, Basel University Hospital, Basel, Switzerland
| | - Thomas F. Lüscher
- Department of Cardiology, Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, London, United Kingdom
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Francois Mach
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
4
|
Aziz D, Yildiz M, Quesada O, Henry TD. COVID-19 STEMI related to microthrombi may lead to coronary microvascular dysfunction. Catheter Cardiovasc Interv 2023; 102:641-645. [PMID: 37622612 DOI: 10.1002/ccd.30797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/29/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023]
Abstract
Coronavirus disease 2019 (COVID-19) increases the risk of ST-segment elevation myocardial infarction (STEMI), and is associated with a higher occurrence of nonobstructive coronary artery disease. We present a unique case of STEMI with concomitant COVID-19 infection in a young female found to have slow flow in multiple vessels on angiography, likely due to microvascular thrombi. Three months later, the patient developed coronary microvascular dysfunction (CMD), suggesting an evolution of microvascular thrombi and injury into subsequent CMD.
Collapse
Affiliation(s)
- Dalia Aziz
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio, USA
| | - Mehmet Yildiz
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio, USA
| | - Odayme Quesada
- Women's Heart Center, The Christ Hospital Heart and Vascular Institute at The Christ Hospital, Cincinnati, Ohio, USA
| | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio, USA
- Women's Heart Center, The Christ Hospital Heart and Vascular Institute at The Christ Hospital, Cincinnati, Ohio, USA
| |
Collapse
|
5
|
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. [PMID: 37762840 PMCID: PMC10532337 DOI: 10.3390/jcm12185899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/30/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
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).
Collapse
Affiliation(s)
- Eugeniusz Hrycek
- American Heart of Poland, Topolowa 16, 32-500 Chrzanów, Poland
- Department of Cardiology, Faculty of Medical Sciences, Andrzej Frycz Modrzewski Kraków University, 30-705 Kraków, Poland
| | - Anna Walawska-Hrycek
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | | | - Krzysztof Milewski
- American Heart of Poland, Armii Krajowej 101, 43-316 Bielsko-Biała, Poland
| | - Przemysław Nowakowski
- American Heart of Poland, Topolowa 16, 32-500 Chrzanów, Poland
- Department of Vascular Surgery, Faculty of Medical Sciences, University of Technology, Rolna 43, 40-555 Katowice, Poland
| | - Piotr Buszman
- Department of Cardiology, Faculty of Medical Sciences, Andrzej Frycz Modrzewski Kraków University, 30-705 Kraków, Poland
- American Heart of Poland, Armii Krajowej 101, 43-316 Bielsko-Biała, Poland
| | - Aleksander Żurakowski
- American Heart of Poland, Topolowa 16, 32-500 Chrzanów, Poland
- Department of Cardiology, Faculty of Medical Sciences, Andrzej Frycz Modrzewski Kraków University, 30-705 Kraków, Poland
| |
Collapse
|
6
|
Zahid S, Jain D, Khan MZ, Kaur G, Michos ED. Readmissions for Myocardial Infarction Among Survivors of COVID-19 Hospitalization: Nationwide Analysis From Pandemic Year 2020. JACC. ADVANCES 2023; 2:100453. [PMID: 38939438 PMCID: PMC11198176 DOI: 10.1016/j.jacadv.2023.100453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2024]
Abstract
Background COVID-19 is known to be associated with acute myocardial infarction (MI). Objectives The purpose of this study was to evaluate the outcomes of 30-day readmissions for MI among survivors of COVID-19 hospitalization. Methods and Results We used the U.S. Nationwide Readmission Database to identify COVID-19 admissions from April 1, 2020, to November 30, 2020, using International Classification of Diseases-10th Revision-Clinical Modification (ICD-10-CM) claims. The primary outcome was 30-day readmission incidence for MI. A total of 521,251 cases of COVID-19 were included, of which 11.6% were readmitted within 30 days of discharge. The 30-day readmission incidence for MI was 0.6%. The 30-day all-cause readmission mortality incidence was 1.3%. Patients readmitted for MI were more frequently males (61.6% vs 38.4%) and had a higher Charlson comorbidity burden score (7 vs 4). The most common diagnosis among 30-day MI readmission was type 2 MI (51.1%), followed by a diagnosis of a type 1 non-ST-segment elevation MI (41.7%). ST-segment elevation MI cases constituted 7.6% of all MI-readmission whereas 0.6% of patients had unstable angina. 30-day MI readmissions with a recurrent diagnosis of COVID-19 had higher readmission mortality and incidence of complications. Conversely, the odds of performing revascularization procedures were lower for MI with recurrent COVID-19. Furthermore, MI readmissions with recurrent COVID-19 had a higher length of stay (7 vs 5 days) and cost of hospitalization ($18,398 vs $16,191) when compared with non-COVID-19 MI readmissions. Conclusions Among survivors of COVID-19 hospitalization, 5.2% of all-cause 30-day readmissions and 12% of all-cause readmission mortality were attributed to MI. MI-related readmissions were a significant source of mortality, morbidity, and resource utilization.
Collapse
Affiliation(s)
- Salman Zahid
- Department of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Deeptanshu Jain
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, USA
| | - Muhammad Zia Khan
- Division of Cardiology, West Virginia University, Morgantown, West Virginia, USA
| | - Gurleen Kaur
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
7
|
Kaya AN, Şahin M. Comparison of the Efficacy and Safety Profiles of Different P2Y12 Inhibitors in Patients With ST-Segment Elevation Myocardial Infarction in the COVID-19 Era. Cureus 2023; 15:e43829. [PMID: 37736426 PMCID: PMC10509489 DOI: 10.7759/cureus.43829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND/AIM Coronavirus Disease 2019 (COVID-19) is characterized by an increased risk of thrombotic and hemorrhagic events resulting from endothelial dysfunction. In patients with ST-elevation myocardial infarction (STEMI), the dual antiplatelet therapy used to reduce mortality may increase the risk of bleeding. The study aimed to compare the efficacy and safety profiles of P2Y12 inhibitors used during the COVID-19 era. MATERIALS AND METHODS Three hundred and ninety patients who underwent primary percutaneous intervention for STEMI between January 1, 2020, and December 31, 2021, were included in this study, retrospectively. The patients were divided into groups according to their COVID-19 history and all-cause mortality, cardiac mortality, stent thrombosis, and bleeding complications during hospitalization and at one-year follow-up were compared. RESULTS The mean age of the patients was 64.3 years and the mean follow-up period was 10.2 months; 80% of the patients were male and 44.6% had a history of COVID-19 infection. The in-hospital mortality rate was 11.3%. Cardiac mortality was significantly higher in the clopidogrel group compared to the other groups, regardless of COVID-19 history (21.9% in the clopidogrel group, 1.6% in the prasugrel group, and 6.7% in the ticagrelor group (p<0.001)). There was no significant difference between the groups in terms of bleeding complications and relation to COVID-19. CONCLUSION In STEMI patients treated with different P2Y12 inhibitors, there was no significant difference in mortality, bleeding, stroke, and thrombotic complications, regardless of the presence or absence of COVID-19 infection.
Collapse
Affiliation(s)
- Ali N Kaya
- Cardiology, Hakkari State Hospital, Hakkari, TUR
| | - Mürsel Şahin
- Cardiology, Karadeniz Technical University Medical School, Trabzon, TUR
| |
Collapse
|
8
|
Jabir A, Geevar Zachariah, Mohanan PP, Gupta MD, Ramakrishnan S, Meena CB, Sridhar L, Girish MP, Das DR, Gupta A, Praveen Nagula, Tom Devasia, Bhavesh Vajifdar, Kamlesh Thakkar, Urmil Shah, Tanuj Bhatia, Smit Srivastava, Sanjeev Sharma, Priya Kubendiran, Jayagopal PB, Sudeep Kumar, Deepthy Sadanandan, Lincy Mathew, Nitish Naik, Anup Banerji, Ashraf SM, Asokan PK, Bharti BB, Majumder B, Dhiman Kahali, Sinha DP, Sharma D, Dastidar DG, Dipankar Mukhapdhyay, Wander GS, Bali HK, Kesavamoorthy B, Agarwala MK, Khanna NN, Natesh BH, Goel PK, Chakraborty RN, Jain RK, Rakesh Yadav, Sameer Dani L, Satyavan Sharma, Satyendra Tewari, Sethi KK, Sharad Chandra, Mandal S, Bhandari S, Sikdar S, Vivek Gupta, Rath PC, Bang VH, Debabrata Roy, Das MK, Banerjee PS. COVID-19 infected ST-Elevation myocardial infarction in India (COSTA INDIA). Indian Heart J 2023; 75:243-250. [PMID: 37230465 PMCID: PMC10204278 DOI: 10.1016/j.ihj.2023.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/09/2023] [Accepted: 05/21/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To find out differences in the presentation, management and outcomes of COVID-19 infected STEMI patients compared to age and sex-matched non-infected STEMI patients treated during the same period. METHODS This was a retrospective multicentre observational registry in which we collected data of COVID-19 positive STEMI patients from selected tertiary care hospitals across India. For every COVID-19 positive STEMI patient, two age and sex-matched COVID-19 negative STEMI patients were enrolled as control. The primary endpoint was a composite of in-hospital mortality, re-infarction, heart failure, and stroke. RESULTS 410 COVID-19 positive STEMI cases were compared with 799 COVID-19 negative STEMI cases. The composite of death/reinfarction/stroke/heart failure was significantly higher among the COVID-19 positive STEMI patients compared with COVID-19 negative STEMI cases (27.1% vs 20.7% p value = 0.01); though mortality rate did not differ significantly (8.0% vs 5.8% p value = 0.13). Significantly lower proportion of COVID-19 positive STEMI patients received reperfusion treatment and primary PCI (60.7% vs 71.1% p value=< 0.001 and 15.4% vs 23.4% p value = 0.001 respectively). Rate of systematic early PCI (pharmaco-invasive treatment) was significantly lower in the COVID-19 positive group compared with COVID-19 negative group. There was no difference in the prevalence of high thrombus burden (14.5% and 12.0% p value = 0.55 among COVID-19 positive and negative patients respectively) CONCLUSIONS: In this large registry of STEMI patients, we did not find significant excess in in-hospital mortality among COVID-19 co-infected patients compared with non-infected patients despite lower rate of primary PCI and reperfusion treatment, though composite of in-hospital mortality, re-infarction, stroke and heart failure was higher.
Collapse
Affiliation(s)
| | | | | | | | | | | | - L Sridhar
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
| | | | | | | | | | - Tom Devasia
- Kasturba Medical College Manipal, Karnataka, India.
| | - Bhavesh Vajifdar
- Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | | | | | | | - Smit Srivastava
- Dr Bhim Rao Ambedhkar Memorial Hospital, Raipur, Chhattisgarh, India.
| | | | - Priya Kubendiran
- G Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India.
| | | | - Sudeep Kumar
- Sanjay Gandhi Postgraduate of Medical Sciences, Lucknow, Uttar Pradesh, India.
| | | | | | - Nitish Naik
- All India Institute of Medical Sciences, Delhi, India.
| | - Anup Banerji
- Medica Superspeciality Hospital, Kolkata, West Bengal, India.
| | - S M Ashraf
- Government Medical College, Kannur, Kerala, India.
| | - P K Asokan
- Fathima Hospital, Kozhikode, Kerala, India.
| | | | | | - Dhiman Kahali
- B M Birla Heart Research Centre, Kolkata, West Bengal, India.
| | | | - Dipak Sharma
- Christian Medical Centre Hospital, Jorht, Assam, India.
| | | | | | | | | | - B Kesavamoorthy
- Meenakshi Multispeciality Hospital, Trichy, Tamil Nadu, India.
| | | | | | - B H Natesh
- Sri Jayadeva Institute of Cardiovascular Science and Research, Bengaluru, Karnataka, India.
| | | | | | | | | | - L Sameer Dani
- Apollo CVHF Heart Institute, Ahmedabad, Gujarat, India.
| | | | - Satyendra Tewari
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
| | - K K Sethi
- Delhi Heart and Lung Institute, New Delhi, India.
| | - Sharad Chandra
- King George Medical University, Lucknow, Uttar Pradesh, India.
| | - Subrato Mandal
- Ubuntu Heart and Superspeciality Hospital, Bhopal, Madhya Pradesh, India.
| | | | | | | | | | | | - Debabrata Roy
- N H Rabindranatha Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India.
| | - Mrinal Kanti Das
- The Calcutta Medical Research Institute, Kolkata, West Bengal, India.
| | | |
Collapse
|
9
|
Rathod KS, Teoh Z, Tyrlis A, Choudry FA, Hamshere SM, Comer K, Guttmann O, Jain AK, Ozkor MA, Wragg A, Archbold RA, Baumbach A, Mathur A, Jones DA. Thrombus Burden and Outcomes in Patients With COVID-19 Presenting With STEMI Across the Pandemic. J Am Coll Cardiol 2023; 81:2406-2416. [PMID: 37344042 DOI: 10.1016/j.jacc.2023.04.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND It has been previously reported during the first COVID-19 outbreak that patients presenting with ST-segment elevation myocardial infarction (STEMI) and concurrent COVID-19 infection have increased thrombus burden and poorer outcomes. To date, there have been no reports comparing the outcomes of COVID-19-positive STEMI patients across all waves of the pandemic. OBJECTIVES This study compared the baseline demographic, procedural, and angiographic characteristics alongside the clinical outcomes of patients presenting with STEMI and concurrent COVID-19 infection across the COVID-19 pandemic in the United Kingdom. METHODS This was a single-center, observational study of 1,269 consecutive patients admitted with confirmed STEMI treated with percutaneous coronary intervention (between January 3, 2020 and October 3, 2022). COVID-19-positive patients were split into 3 groups based upon the time course of the pandemic, and a comparison was made between waves. RESULTS A total of 154 COVID-19-positive patients with STEMI were included in the present analysis and were compared with 1,115 COVID-19-negative patients. Early during the pandemic (wave 1), STEMI patients presenting with concurrent COVID-19 infection had high rates of cardiac arrest, evidence of increased thrombus burden, bigger infarcts, and worse outcomes. However, by wave 3, no differences existed in outcomes between COVID-19-positive and -negative patients, with significant differences compared with earlier COVID-19-positive patients. Poor outcomes later in the study period were predominantly in unvaccinated individuals. CONCLUSIONS Significant changes have occurred in the clinical characteristics, angiographic features, and outcomes of STEMI patients with COVID-19 infection treated by primary percutaneous coronary intervention during the course of the pandemic. Importantly, outcomes of recent waves and in vaccinated individuals are no different to a non-COVID-19 population.
Collapse
Affiliation(s)
- Krishnaraj S Rathod
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Zhi Teoh
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Angelos Tyrlis
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Fizzah A Choudry
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Stephen M Hamshere
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Katrina Comer
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Oliver Guttmann
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Ajay K Jain
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Muhiddin A Ozkor
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Andrew Wragg
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - R Andrew Archbold
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Daniel A Jones
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.
| |
Collapse
|
10
|
Patel KN, Majmundar M, Vasudeva R, Doshi R, Kaur A, Mehta H, Gupta K. Impact of Gender, Race, and Insurance Status on Inhospital Management and Outcomes in Patients With COVID-19 and ST-Elevation Myocardial Infarction (a Nationwide Analysis). Am J Cardiol 2023; 198:14-25. [PMID: 37196529 DOI: 10.1016/j.amjcard.2023.04.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/30/2023] [Accepted: 04/15/2023] [Indexed: 05/19/2023]
Abstract
There is a paucity of data exploring the impact of gender, race, and insurance status on invasive management and inhospital mortality in patients with COVID-19 with ST-elevation myocardial infarction (STEMI) in the United States. The National Inpatient Sample database for the year 2020 was queried to identify all adult hospitalizations with STEMI and concurrent COVID-19. A total of 5,990 patients with COVID-19 with STEMI were identified. Women had 31% lower odds of invasive management and 32% lower odds of coronary revascularization than men. Black patients had lower odds of invasive management (odds ratio [OR] 0.61, 95% confidence interval [CI] 0.43 to 0.85, p = 0.004) than White patients. Black and Asian patients had lower odds of percutaneous coronary intervention (Black: OR 0.55, 95% CI 0.38 to 0.80, p = 0.002; Asian: OR 0.39, 95% CI 0.18 to 0.85, p = 0.018) than White patients. Uninsured patients had higher odds of getting percutaneous coronary intervention (OR 1.78, 95% CI 1.05 to 2.98, p = 0.031) and lower odds of inhospital mortality (OR 0.41, 95% CI 0.19 to 0.89, p = 0.023) than privately insured patients. Patients with out-of-hospital STEMI had 19 times higher odds of invasive management and 80% lower odds of inhospital mortality than inhospital STEMI. In conclusion, we note important gender and racial disparities in invasive management of patients with COVID-19 with STEMI. Surprisingly, uninsured patients had higher revascularization rates and lower mortality than privately insured patients.
Collapse
Affiliation(s)
- Kunal N Patel
- Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey
| | - Monil Majmundar
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Rhythm Vasudeva
- Department of Internal Medicine, University of Kansas School of Medicine, Wichita, Kansas
| | - Rajkumar Doshi
- Department of Cardiology, St. Joseph's University Medical Center, Paterson, New Jersey
| | - Avleen Kaur
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Harsh Mehta
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Kamal Gupta
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas.
| |
Collapse
|
11
|
Vosko I, Zirlik A, Bugger H. Impact of COVID-19 on Cardiovascular Disease. Viruses 2023; 15:508. [PMID: 36851722 PMCID: PMC9962056 DOI: 10.3390/v15020508] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/30/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a viral infection with the novel severe acute respiratory distress syndrome corona virus 2 (SARS-CoV-2). Until now, more than 670 million people have suffered from COVID-19 worldwide, and roughly 7 million death cases were attributed to COVID-19. Recent evidence suggests an interplay between COVID-19 and cardiovascular disease (CVD). COVID-19 may serve as a yet underappreciated CVD risk modifier, including risk factors such as diabetes mellitus or arterial hypertension. In addition, recent data suggest that previous COVID-19 may increase the risk for many entities of CVD to an extent similarly observed for traditional cardiovascular (CV) risk factors. Furthermore, increased CVD incidence and worse clinical outcomes in individuals with preexisting CVD have been observed for myocarditis, acute coronary syndrome, heart failure (HF), thromboembolic complications, and arrhythmias. Direct and indirect mechanisms have been proposed by which COVID-19 may impact CVD and CV risk, including viral entry into CV tissue or by the induction of a massive systemic inflammatory response. In the current review, we provide an overview of the literature reporting an interaction between COVID-19 and CVD, review potential mechanisms underlying this interaction, and discuss preventive and treatment strategies and their interference with CVD that were evaluated since the onset of the COVID-19 pandemic.
Collapse
Affiliation(s)
| | | | - Heiko Bugger
- Department of Cardiology, Medical University of Graz, 8036 Graz, Austria
| |
Collapse
|
12
|
Rymer JA, Kirtane AJ, Farb A, Malone M, Jaff MR, Seward K, Stephens D, Barakat MK, Krucoff MW. One-Year Follow-Up of Vascular Intervention Trials Disrupted by the COVID-19 Pandemic: A Use-Case landscape. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 45:67-73. [PMID: 35953406 PMCID: PMC9323208 DOI: 10.1016/j.carrev.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The COVID-19 pandemic had an unprecedented impact on cardiovascular clinical research. The decision-making and state of study operations in cardiovascular trials 1-year after interruption has not been previously described. METHODS In the spring of 2020, we created a pandemic impact task force to develop a landscape of use case scenarios from 17 device trials of peripheral artery disease (PAD) and coronary artery disease (CAD) interventions. In conjunction with publicly available (clinictrials.gov) study inclusion criteria, primary endpoints and study design, information was shared for this use-case landscape by trial leadership and data owners. RESULTS A total of 17 actively enrolling trials (9 CAD and 8 PAD) volunteered to populate the use case landscape. All 17 were multicenter studies (12 in North America and 5 international). Fifteen studies were industry-sponsored, of which 13 were FDA approved IDEs, one was PCORI-sponsored and two were sponsored by the NIH. Enrollment targets ranged from 150 to 9000 pts. At the time of interruption, 5 trials were <20 % enrolled, 9 trials were 50-80 % enrolled and 3 trials were >80 % enrolled. At 1 year, the majority of studies were continuing to enroll in the context of more sporadic but ongoing pandemic activity. CONCLUSIONS At 1 year from the first surge interruptions, most trials had resumed enrollment. Trials most heavily interrupted were trials early in enrollment and those trials not able to pivot to virtual patient and site visits. Further work is needed to determine the overall impact on vascular intervention trials disrupted during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Jennifer A. Rymer
- Duke University School of Medicine, Durham, NC, United States of America,Duke Clinical Research Institute, Durham, NC, United States of America,Corresponding author at: Duke University Medical Center, 2301 Erwin Road, Durham, NC 27705, United States of America
| | - Ajay J. Kirtane
- Columbia University Irving Medical Center, New York, United States of America
| | - Andrew Farb
- US Food and Drug Administration, Silver Spring, MD, United States of America
| | - Misti Malone
- US Food and Drug Administration, Silver Spring, MD, United States of America
| | - Michael R. Jaff
- Boston Scientific Corporation, Marlborough, MA, United States of America
| | - Kirk Seward
- Mercator MedSystems, Inc., Emeryvlle, CA, United States of America
| | - Dan Stephens
- Boston Scientific Corporation, Marlborough, MA, United States of America
| | - Mark K. Barakat
- CeloNova BioSciences, San Antonio, TX, United States of America
| | - Mitchell W. Krucoff
- Duke University School of Medicine, Durham, NC, United States of America,Duke Clinical Research Institute, Durham, NC, United States of America
| |
Collapse
|
13
|
De Luca G, Silverio A, Verdoia M, Siudak Z, Tokarek T, Kite TA, Gershlick AH, Rodriguez-Leor O, Cid-Alvarez B, Jones DA, Rathod KS, Montero-Cabezas JM, Jurado-Roman A, Nardin M, Galasso G. Angiographic and clinical outcome of SARS-CoV-2 positive patients with ST-segment elevation myocardial infarction undergoing primary angioplasty: A collaborative, individual patient data meta-analysis of six registry-based studies. Eur J Intern Med 2022; 105:69-76. [PMID: 35999094 PMCID: PMC9385833 DOI: 10.1016/j.ejim.2022.08.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The characteristics and outcome of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients with ST-Elevation Myocardial Infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) are still poorly known. METHODS The PANDEMIC study was an investigator-initiated, collaborative, individual patient data (IPD) meta-analysis of registry-based studies. MEDLINE, ScienceDirect, Web of Sciences, and SCOPUS were searched to identify all registry-based studies describing the characteristics and outcome of SARS-CoV-2-positive STEMI patients undergoing PPCI. The control group consisted of SARS-CoV-2-negative STEMI patients undergoing PPCI in the same time period from the ISACS-STEMI COVID 19 registry. The primary outcome was in-hospital mortality; the secondary outcome was postprocedural reperfusion assessed by TIMI flow. RESULTS Of 8 registry-based studies identified, IPD were obtained from 6 studies including 941 SARS-CoV-2-positive patients; the control group included 2005 SARS-CoV-2-negative patients. SARS-CoV-2-positive patients showed a significantly higher in-hospital mortality (p < 0.001) and worse postprocedural TIMI flow (<3, p < 0.001) compared with SARS-CoV-2-negative subjects. The increased risk for SARS-CoV-2-positive patients was significantly higher in males compared to females for both the primary (pinteraction = 0.001) and secondary outcome (pinteraction = 0.023). In SARS-CoV-2-positive patients, age ≥ 75 years (OR = 5.72; 95%CI: 1.77-18.5), impaired postprocedural TIMI flow (OR = 11.72; 95%CI: 2.64-52.10), and cardiogenic shock at presentation (OR = 11.02; 95%CI: 2.84-42.80) were independent predictors of mortality. CONCLUSIONS In STEMI patients undergoing PPCI, SARS-CoV-2 positivity is independently associated with impaired reperfusion and with a higher risk of in-hospital mortality, especially among male patients. Age ≥ 75 years, cardiogenic shock, and impaired postprocedural TIMI flow independently predict mortality in this high-risk population.
Collapse
Affiliation(s)
- Giuseppe De Luca
- Division of Clinical and Experimental Cardiology, Azienda Ospedaliero-Universitaria Sassari, Viale S. Pietro, 43/B, Sassari 07100, Italy; Division of Clinical and Interventional Cardiology, Istituto Clinico Sant'Ambrogio, Milano, Italy.
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Monica Verdoia
- Division of Cardiology, Ospedale degli Infermi, ASL, Biella, Italy
| | | | - Tomasz Tokarek
- Institute of Cardiology, Jagiellonian University Medical College, Kopernika 17 Street, Kraków 31-501, Poland; 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Thomas A Kite
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Anthony H Gershlick
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Oriol Rodriguez-Leor
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; CIBER de Enfermedades CardioVasculares (CIBERCV) Instituto de Salud Carlos III, Madrid, Spain; Institut de Recerca en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Belen Cid-Alvarez
- Servicio de Cardiología, Hospital Clínico de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Daniel A Jones
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Krishnaraj S Rathod
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | | | | | - Matteo Nardin
- Department of Internal Medicine, Ospedale Riuniti, Brescia, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| |
Collapse
|
14
|
Alekyan BG, Boytsov SA, Ganyukov VI, Manoshkina EM. Impact of the COVID-19 Pandemic on Myocardial Revascularization in Patients with Acute Coronary Syndrome in the Russian Federation. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2022. [DOI: 10.20996/1819-6446-2022-08-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim. To compare and analyze the results of myocardial revascularization in the Russian Federation (RF) with acute coronary syndrome (ACS) before the onset (2018-2019) and during the novel coronavirus infection (COVID-19) pandemic (2020-2021).Material and methods. The analysis included the number of cases of ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation acute coronary syndrome (NSTE-ACS), the number of cases of myocardial revascularization in the above forms of ACS, the number of deaths depending on the form of ACS and the method performed revascularization. The period of time before the start of the coronavirus pandemic corresponded to the annual data received in the Russian Federation for 2018-2019. The period of the coronavirus disease pandemic corresponded to the annual data received in the country for 2020-2021. Absolute, relative, estimated values of patient hospitalization, myocardial revascularization procedures, and mortality in ACS were compared between time periods before and during the COVID-19 pandemic. The data for analysis were obtained from the monitoring of the Ministry of Health of Russia.Results. In 2018 and 2019 in the RF, 531,019 and 501,238 patients were hospitalized with a diagnosis of ACS, and during the pandemic (2020-2021) - 403,931 and 397,930 patients, respectively. Reduction in the number of patients diagnosed with ACS admitted to hospitals in Russia by 22.32% in 2020-2021 years was mainly due to a significant decrease in hospitalizations of patients with a diagnosis of NSTE-ACS (by 29.03%). At the same time, admission to clinics of patients with STEMI decreased only by 6.02%. During the COVID-19 pandemic, mortality increased significantly in PPCI (by 9.6%) and in the general STEMI group (by 12.3%); significantly increased mortality both in the general group (by 48%) and during PCI in patients with NSTE-ACS (by 28.6%); there was an increase in the average annual number of PPCI (by 12.6%), which was accompanied by an increased average annual number of PPCI per 1 million of population (up to 451 per 1 million of population); a slight increase in the average time "symptom-balloon" (by 2 minutes) was recorded; there was an absolute slight decrease and a relative increase in the number of PCIs in NSTE-ACS (by 2.7% and 37.1%, respectively). In 2021, in the Russian Federation, primary PCI was performed in 50.2%, thrombolytic therapy - in 23.1%, and 26.7% of patients remained without reperfusion. Pharmacoinphasive strategy was applied in 60%, and isolated thrombolysis - in 40% of patients.Conclusion. During the COVID-19 pandemic, revascularization in patients with ACS in Russia corresponded to the following trends recorded in the literature: increased hospital mortality in PPCI and in the general STEMI group; hospital mortality both in the general group and during PCI in patients with NSTE-ACS. The indicators of myocardial revascularization in ACS in the RF during the pandemic were fundamentally different from the data of Western countries: there was an increase in the average annual number of PPCI and the average annual number of PPCI per 1 million population; a slight increase in the average symptom-balloon time was recorded; revealed an absolute slight decrease and a relative increase in the number of PCIs in NSTE-ACS.
Collapse
Affiliation(s)
- B. G. Alekyan
- National Medical Research Center of Surgery named after A. Vishnevsky
| | - S. A. Boytsov
- National Medical Research Center of Cardiology named after academician E.I. Chazov; A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - V. I. Ganyukov
- Research Institute for Complex Issues of Cardiovascular Diseases
| | | |
Collapse
|
15
|
Comparison of Angiographic and Clinical Outcomes After Primary Percutaneous Coronary Intervention for ST-elevation Myocardial Infarction Between Patients With and Without Concomitant COVID-19 Infection. Crit Pathw Cardiol 2022; 21:141-146. [PMID: 35994723 DOI: 10.1097/hpc.0000000000000297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE COVID-19 infection can involve the cardiovascular system and worsen the prognosis of the patients. This study aimed to investigate the adverse effects of COVID-19 on angiographic and clinical outcomes of primary percutaneous coronary intervention (PCI) in patients with acute ST-elevation MI and compare results with those patients without COVID-19 disease. METHODS The study was a retrospective observational cohort, in which patients presented with ST-elevation MI from February 2020 to April 2021, treated with primary PCI were divided into 2 groups based on the COVID-19 infection. Then, the procedural and angiographic indices and also clinical outcomes were compared between the 2 groups. RESULTS A total of 1150 patients were enrolled in the study. Those with established COVID-19 infection had worse baseline thrombolysis in myocardial infarction flow grade and also were at higher risk for worse procedural outcomes such as lower thrombolysis in myocardial infarction frame count, myocardial blush grade, and slow-flow coronary disease, after the primary PCI. Additionally, the presence of COVID-19 at the time of primary PCI was related to a significantly higher duration of hospitalization and in-hospital mortality. Given the potential impact of other factors on outcomes, analysis for all of the primary endpoints was done again after adjustment of these factors and the results were the same as before, suggesting the independent effect of COVID-19 infection. CONCLUSIONS The concomitant COVID-19 infection in the patients undergoing primary PCI is associated with significantly worse angiographic, procedural and clinical outcomes. Surprisingly, this finding is regardless of patients' baseline risk factors and demographical characteristics.
Collapse
|
16
|
Mohammad KO, Rodriguez JBC, Urey MA. Coronavirus disease 2019 and the cardiologist. Curr Opin Cardiol 2022; 37:335-342. [PMID: 35731679 DOI: 10.1097/hco.0000000000000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW There continues to be extensive clinical and epidemiological data to suggest that coronavirus disease 2019 (COVID-19) infection is associated with numerous different types of cardiac involvement. RECENT FINDINGS Myocardial injury has been reported in over 25% of patients hospitalized due to COVID-19 infection and is not only associated with a worse prognosis but with higher mortality, approaching 40%. Currently proposed mechanisms of myocardial injury include direct viral infection, cytokine storm, endothelial inflammation, demand ischemia, interferon-mediated response and stress cardiomyopathy. COVID-19 infection is associated with new-onset arrhythmias and heart failure regardless of history of previous cardiovascular disease. Echocardiographic findings can be useful to predict mortality in COVID-19 patients and cardiac MRI is an effective tool to both assess COVID-19 induced myocarditis and to follow-up on cardiac complications of COVID-19 long-term. Although there is an association between COVID-19 vaccination and myocarditis, pericarditis or arrhythmias, the risk appears lower when compared to risk attributable to the natural infection. SUMMARY Patients with cardiovascular disease are not only more likely to suffer from severe COVID-19 infection but are at increased risk for further complications and higher mortality. Further data compilation on current and emerging treatments of COVID-19 will have additional impact on cardiovascular morbidity and mortality of COVID-19 infection.
Collapse
Affiliation(s)
- Khan O Mohammad
- Department of Internal Medicine, Dell Medical School at the University of Texas, Austin, Texas
| | - Jose B Cruz Rodriguez
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Marcus A Urey
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, San Diego, California, USA
| |
Collapse
|
17
|
Quesada O, Van Hon L, Yildiz M, Madan M, Sanina C, Davidson L, Htun WW, Saw J, Garcia S, Dehghani P, Stanberry L, Bortnick A, Henry TD, Grines CL, Benziger C. Sex Differences in Clinical Characteristics, Management Strategies, and Outcomes of STEMI With COVID-19: NACMI Registry. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100360. [PMID: 35812987 PMCID: PMC9117757 DOI: 10.1016/j.jscai.2022.100360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 12/11/2022]
|
18
|
Alasnag M, Shah B, Botti G, Zaman S, Chieffo A. STEMIs and a Closer Look at MINOCA During the COVID-19 Pandemic. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100372. [PMID: 35795878 PMCID: PMC9117730 DOI: 10.1016/j.jscai.2022.100372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
|
19
|
Verdoia M, Gioscia R, Rognoni A. Updates on the Management of STEMI in 2021: Beyond COVID-19. J Am Coll Cardiol 2022; 79:2245-2246. [PMID: 35654495 DOI: 10.1016/j.jacc.2022.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Monica Verdoia
- Division of Cardiology Ospedale degli Infermi, ASL Biella, Italy.
| | - Rocco Gioscia
- Division of Cardiology Ospedale degli Infermi, ASL Biella, Italy
| | - Andrea Rognoni
- Division of Cardiology Ospedale degli Infermi, ASL Biella, Italy
| |
Collapse
|
20
|
Singh J, Durr MRR, Deptuch E, Sultana S, Mehta N, Garcia S, Henry TD, Dehghani P. Cardiac Registries During the COVID-19 Pandemic: Lessons Learned. Curr Cardiol Rep 2022; 24:659-665. [PMID: 35380385 PMCID: PMC8981885 DOI: 10.1007/s11886-022-01686-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE OF THIS REVIEW We discuss the role of observational studies and cardiac registries during the COVID-19 pandemic. We focus on published cardiac registries and highlight contributions to the field that have had clinical implications. RECENT FINDINGS We included observational studies of COVID-19 patients published in peer-reviewed medical journals with defined inclusion and exclusion criteria, defined study design, and primary outcomes. A PubMed and MEDLINE literature review results in 437 articles, of which 52 include patients with COVID-19 with cardiac endpoints. From July 2020 to December 2021, the average time from last data collected to publication was 8.9 ± 4.1 months, with an increasing trend over time (R = 0.9444, p < 0.0001). Of the 52 articles that met our inclusion criteria, we summarize main findings of 4 manuscripts on stroke, 14 on acute coronary syndrome, 4 on cardiac arrest, 7 on heart failure, 7 on venous thromboembolism, 5 on dysrhythmia, and 11 on different populations at risk for cardiovascular. Registries are cost effective, not disruptive to essential health services, and can be rapidly disseminated with short intervals between last data point collected and publication. In less than 2 years, cardiac registries have filled important gaps in knowledge and informed the care of COVID-19 patients with cardiovascular conditions.
Collapse
Affiliation(s)
| | | | | | | | - Neha Mehta
- Prairie Vascular Research Inc, Regina, SK, Canada
| | - Santiago Garcia
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH, USA
| | | |
Collapse
|
21
|
Garcia S, Dehghani P, Stanberry L, Grines C, Patel RAG, Nayak KR, Singh A, Htun WW, Kabour A, Ghasemzadeh N, Sanina C, Aragon J, Alraies C, Benziger C, Okeson B, Garberich R, Welt FG, Davidson L, Hafiz AM, Acharya D, Stone J, Mehra A, Amlani S, Mahmud E, Giri J, Yildiz M, Henry TD. Trends in Clinical Characteristics, Management Strategies and Outcomes of STEMI Patients with COVID-19. J Am Coll Cardiol 2022; 79:2236-2244. [PMID: 35390486 PMCID: PMC8978699 DOI: 10.1016/j.jacc.2022.03.345] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 11/17/2022]
Abstract
Background We previously reported high in-hospital mortality for ST-segment elevation myocardial infarction (STEMI) patients with COVID-19 treated in the early phase of the pandemic. Objectives The purpose of this study was to describe trends of COVID-19 patients with STEMI during the course of the pandemic. Methods The NACMI (North American COVID-19 STEMI) registry is a prospective, investigator-initiated, multicenter, observational registry of hospitalized STEMI patients with confirmed or suspected COVID-19 infection in North America. We compared trends in clinical characteristics, management, and outcomes of patients treated in the first year of the pandemic (January 2020 to December 2020) vs those treated in the second year (January 2021 to December 2021). Results A total of 586 COVID-19–positive patients with STEMI were included in the present analysis; 227 treated in Y2020 and 359 treated in Y2021. Patients’ characteristics changed over time. Relative to Y2020, the proportion of Caucasian patients was higher (58% vs 39%; P < 0.001), patients presented more frequently with typical ischemic symptoms (59% vs 51%; P = 0.04), and patients were less likely to have shock pre-PCI (13% vs 18%; P = 0.07) or pulmonary manifestations (33% vs. 47%; P = 0.001) in Y2021. In-hospital mortality decreased from 33% (Y2020) to 23% (Y2021) (P = 0.008). In Y2021, none of the 22 vaccinated patients expired in hospital, whereas in-hospital death was recorded in 37 (22%) unvaccinated patients (P = 0.009). Conclusions Significant changes have occurred in the clinical characteristics and outcomes of STEMI patients with COVID-19 infection during the course of the pandemic.
Collapse
Affiliation(s)
- Santiago Garcia
- Minneapolis Heart Institute Foundation. Minneapolis, MN; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH
| | - Payam Dehghani
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada
| | | | - Cindy Grines
- Northside Cardiovascular Institute, Atlanta, GA and Society for Cardiovascular Angiography and Interventions (SCAI), Washington, DC
| | | | - Keshav R Nayak
- Department of Cardiology Scripps Mercy Hospital, San Diego, CA
| | - Avneet Singh
- North Shore University Hospital & Long Island Jewish Medical Center (NS/LIJ)
| | | | | | - Nima Ghasemzadeh
- Georgia Heart Institute, Northeast Georgia Medical Center, Gainesville, Georgia
| | - Cristina Sanina
- Montefiore Medical Center and Albert Einstein College of Medicine. New York City, NY
| | | | | | | | - Brynn Okeson
- Minneapolis Heart Institute Foundation. Minneapolis, MN
| | | | - Frederick G Welt
- American College of Cardiology Interventional Cardiology Section Leadership Council, Washington, DC and University of Utah Health Sciences, Salt Lake City, Utah
| | - Laura Davidson
- Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Abdul Moiz Hafiz
- Southern Illinois University School of Medicine. Springfield, IL
| | | | - Jay Stone
- Community Medical Center (RWJ Barnabas Health). Toms River, NJ
| | - Aditya Mehra
- Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ
| | - Shy Amlani
- William Osler Health System- Brampton, Brampton, Ontario, Canada
| | - Ehtisham Mahmud
- University of California, San Diego, Sulpizio Cardiovascular Center, La Jolla CA
| | - Jay Giri
- University of Pennsylvania, Philadelphia, PA
| | - Mehmet Yildiz
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH
| | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH
| |
Collapse
|
22
|
Comparison of Coronary Artery Involvement and Mortality in STEMI Patients With and Without SARS-CoV-2 During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2022; 47:101032. [PMID: 34718033 PMCID: PMC8552666 DOI: 10.1016/j.cpcardiol.2021.101032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/16/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cardiovascular injury with SARS-CoV-2 infection is well known. Several studies have outlined baseline characteristics in patients presenting with STEMI and SARS-CoV-2. Paucity in data exists in selective coronary involvement in patients with STEMI and SARS-CoV-2 during the COVID-19 pandemic. METHODS A systematic search and meta-analysis of studies meeting the inclusion and exclusion criteria obtained from MEDLINE, Scopus, and Cochrane databases was performed utilizing PRISMA criteria. The main outcome was likelihood of coronary artery involvement among patients with STEMI and SARS-CoV-2 versus without SARS-CoV-2. The primary adverse outcome measured was in-hospital mortality. RESULTS The final analysis included 5 observational studies with a total of 2,266 patients. There was no statistical significance in LM (OR 1.40; 95% CI: 0.68, 2.90), LAD (OR 1.09; 95% CI 0.83, 1.43), LCX (OR 1.17; 95% CI: 0.75, 1.85), or RCA (OR 0.59; 95% CI: 0.30, 1.17) disease among the 2 groups. LAD disease was the most prevalent coronary involvement among patients with STEMI and SARS-CoV-2 (49.6%). Higher in-hospital mortality was observed in the STEMI and SARS-CoV-2 group (OR 5.24; 95% CI: 3.63, 7.56). CONCLUSIONS Our analysis demonstrated no statistical significance in selective coronary involvement in patients with STEMI and SARS-CoV-2 during the COVID-19 pandemic. The higher mortality among patients with SARS-CoV-2 and STEMI has been noted in prior studies with concerns being late presentation due to fear of infection, delayed care time, and poor resource allocation. Focus should be placed on identifying and managing comorbidities to reduce mortality.
Collapse
Key Words
- (CAD), coronary artery disease
- (COVID-19), coronavirus disease 2019
- (LAD), left anterior descending
- (LCX), left circumflex
- (LM), left main
- (OR), odds ratio
- (PRISMA), Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- (RCA), right coronary artery
- (SARS-CoV-2), severe acute respiratory syndrome coronavirus 2
- (STEMI), ST segment elevation myocardial infarction
Collapse
|
23
|
Skorupski WJ, Grygier M, Lesiak M, Kałużna-Oleksy M. Coronary Stent Thrombosis in COVID-19 Patients: A Systematic Review of Cases Reported Worldwide. Viruses 2022; 14:v14020260. [PMID: 35215853 PMCID: PMC8876054 DOI: 10.3390/v14020260] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 12/12/2022] Open
Abstract
Approximately 5 million percutaneous coronary interventions are performed worldwide annually. Therefore, stent-related complications pose a serious public health concern. Stent thrombosis, although rare, is usually catastrophic, often associated with extensive myocardial infarction or death. Because little progress has been made in outcomes following stent thrombosis, ongoing research is focusing on further understanding the predictors as well as frequency and timing in various patient subgroups. Coronavirus disease-2019 (COVID-19), a viral illness caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), activates inflammatory mechanisms that potentially create a prothrombotic environment and increases the risk of local micro thromboembolism and all types of stent thrombosis. In-stent thrombosis occurrence increased during the COVID-19 pandemic, however, there is still lack of comprehensive studies describing this population. This review and worldwide analysis of coronary stent thrombosis cases related to COVID-19 summarizes all available data.
Collapse
|
24
|
Gurbel PA, Tantry US. In vitro evidence for the role of cytokine storm in the generation of stent thrombosis in COVID -19 patients. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 35:139-140. [PMID: 34872848 PMCID: PMC8635684 DOI: 10.1016/j.carrev.2021.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Paul A Gurbel
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Lifebridge Health, Baltimore, MD, USA.
| | - Udaya S Tantry
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Lifebridge Health, Baltimore, MD, USA
| |
Collapse
|
25
|
Affiliation(s)
- Alexander C Fanaroff
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia
| | - Santiago Garcia
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia
| |
Collapse
|
26
|
Zuin M, Rigatelli G, Zuliani G, Roncon L. Mortality and in-stent thrombosis in COVID-19 patients with STEMI: More work ahead. Atherosclerosis 2021; 336:48. [PMID: 34416979 PMCID: PMC8357484 DOI: 10.1016/j.atherosclerosis.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/06/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
| | | | - Giovanni Zuliani
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Loris Roncon
- Department of Cardiology, Rovigo General Hospital, Rovigo, Italy
| |
Collapse
|
27
|
Verdoia M, De Luca G. Reply to: "Mortality and in-stent thrombosis in COVID-19 patients with STEMI: More work ahead". Atherosclerosis 2021; 336:49-50. [PMID: 34635335 PMCID: PMC8442288 DOI: 10.1016/j.atherosclerosis.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/08/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Monica Verdoia
- Department of Cardiology, Nuovo Ospedale degli Infermi, ASL Biella, Italy; Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Novara, Italy; Deparment of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Giuseppe De Luca
- Department of Cardiology, Nuovo Ospedale degli Infermi, ASL Biella, Italy; Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Novara, Italy; Deparment of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
| |
Collapse
|