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Observational Study
. 2021 Apr;8(1):e001617.
doi: 10.1136/openhrt-2021-001617.

Undiagnosed SARS-CoV-2 infection and outcome in patients with acute MI and no COVID-19 symptoms

Zubair Akhtar  1 , Fahmida Chowdhury  2 , Mohammad Abdul Aleem  2   3 , Probir Kumar Ghosh  2 , Mahmudur Rahman  2 , Mustafizur Rahman  2 , Mohammad Enayet Hossain  2 , Mariya Kibtiya Sumiya  2 , A K M Monwarul Islam  4 , Mir Jamal Uddin  4 , C Raina MacIntyre  3 , Sara Cajander  5 , Ole Frobert  6
Affiliations
Observational Study

Undiagnosed SARS-CoV-2 infection and outcome in patients with acute MI and no COVID-19 symptoms

Zubair Akhtar et al. Open Heart. 2021 Apr.

Abstract

Objective: We aimed to determine the prevalence and outcome of occult infection with SARS-CoV-2 and influenza in patients presenting with myocardial infarction (MI) without COVID-19 symptoms.

Methods: We conducted an observational study from 28 June to 11 August 2020, enrolling patients admitted to the National Institute of Cardiovascular Disease Hospital, Dhaka, Bangladesh, with ST-segment elevation MI (STEMI) or non-ST-segment elevation MI who did not meet WHO criteria for suspected COVID-19. Samples were collected by nasopharyngeal swab to test for SARS-CoV-2 and influenza virus by real-time reverse transcriptase PCR. We followed up patients at 3 months (13 weeks) postadmission to record adverse cardiovascular outcomes: all-cause death, new MI, heart failure and new percutaneous coronary intervention or stent thrombosis. Survival analysis was performed using the Kaplan-Meier method.

Results: We enrolled 280 patients with MI, 79% male, mean age 54.5±11.8 years, 140 of whom were diagnosed with STEMI. We found 36 (13%) to be infected with SARS-CoV-2 and 1 with influenza. There was no significant difference between mortality rate observed among SARS-CoV-2 infected patients compared with non-infected (5 (14%) vs 26 (11%); p=0.564). A numerically shorter median time to a recurrent cardiovascular event was recorded among SARS-CoV-2 infected compared with non-infected patients (21 days, IQR: 8-46 vs 27 days, IQR: 7-44; p=0.378).

Conclusion: We found a substantial rate of occult SARS-CoV-2 infection in the studied cohort, suggesting SARS-CoV-2 may precipitate MI. Asymptomatic patients with COVID-19 admitted with MI may contribute to disease transmission and warrants widespread testing of hospital admissions.

Keywords: COVID-19; NSTEMI; STEMI.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Daily test positivity rate for SARS-CoV-2 infection in Bangladesh and study hospital (National Institute of Cardiovascular Diseases) from 28 June to 11 August 2020.
Figure 2
Figure 2
Three-month (13 weeks) survival rate of patients with MI in Bangladesh during COVID-19 pandemic (June–November 2020).
See this image and copyright information in PMC

References

    1. Wang D, Hu B, Hu C, et al. . Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323:1061. 10.1001/jama.2020.1585 - DOI - PMC - PubMed
    1. Williamson EJ, Walker AJ, Bhaskaran K, et al. . Factors associated with COVID-19-related death using OpenSAFELY. Nature 2020;584:430–6. 10.1038/s41586-020-2521-4 - DOI - PMC - PubMed
    1. Pérez-Bermejo JA, Kang S, Rockwood SJ, et al. . SARS-CoV-2 infection of human iPSC-derived cardiac cells predicts novel cytopathic features in hearts of COVID-19 patients. bioRxiv 2020. 10.1101/2020.08.25.265561. [Epub ahead of print: 12 Sep 2020]. - DOI - PMC - PubMed
    1. Hayek SS, Brenner SK, Azam TU, et al. . In-Hospital cardiac arrest in critically ill patients with covid-19: multicenter cohort study. BMJ 2020;371:m3513. 10.1136/bmj.m3513 - DOI - PMC - PubMed
    1. Shi S, Qin M, Shen B, et al. . Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol 2020;5:802–10. 10.1001/jamacardio.2020.0950 - DOI - PMC - PubMed

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