Comparison of the Characteristics, Management, and Outcomes of STEMI Patients Presenting With vs. Those of Patients Presenting Without COVID-19 Infection: A Systematic Review and Meta-Analysis

Abstract

Objectives: This study aimed to investigate the differences in the characteristics, management, and clinical outcomes of patients with and that of those without coronavirus disease 2019 (COVID-19) infection who had ST-segment elevation myocardial infarction (STEMI).

Methods: Databases including Web of Science, PubMed, Cochrane Library, and Embase were searched up to July 2021. Observational studies that reported on the characteristics, management, or clinical outcomes and those published as full-text articles were included. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of all included studies.

Results: A total of 27,742 patients from 13 studies were included in this meta-analysis. Significant delay in symptom onset to first medical contact (SO-to-FMC) time (mean difference = 23.42 min; 95% CI: 5.85-40.99 min; p = 0.009) and door-to-balloon (D2B) time (mean difference = 12.27 min; 95% CI: 5.77-18.78 min; p = 0.0002) was observed in COVID-19 patients. Compared to COVID-19 negative patients, those who are positive patients had significantly higher levels of C-reactive protein, D-dimer, and thrombus grade (p < 0.05) and showed more frequent use of thrombus aspiration and glycoprotein IIbIIIa (Gp2b3a) inhibitor (p < 0.05). COVID-19 positive patients also had higher rates of in-hospital mortality (OR = 5.98, 95% CI: 4.78-7.48, p < 0.0001), cardiogenic shock (OR = 2.75, 95% CI: 2.02-3.76, p < 0.0001), and stent thrombosis (OR = 5.65, 95% CI: 2.41-13.23, p < 0.0001). They were also more likely to be admitted to the intensive care unit (ICU) (OR = 4.26, 95% CI: 2.51-7.22, p < 0.0001) and had a longer length of stay (mean difference = 4.63 days; 95% CI: 2.56-6.69 days; p < 0.0001).

Conclusions: This study revealed that COVID-19 infection had an impact on the time of initial medical intervention for patients with STEMI after symptom onset and showed that COVID-19 patients with STEMI were more likely to have thrombosis and had poorer outcomes.

Keywords: COVID-19; SARS-CoV-2; ST-segment elevation myocardial infarction; STEMI; mortality.

Figure 1

PRISMA flow diagram.

Figure 2

(A) Symptom onset to first medical contact (SO-to-FMC) time forest plot (minutes). (B) Door to balloon (D2B) time forest plot (minutes).

Figure 3

(A) C-reactive protein (CRP) forest plot (mg/dl). (B) White blood cell (WBC) forest plot (*10⁹/L). (C) D-dimer forest plot (mg/L). (D) Lymphocyte count forest plot (*10⁹/L).

Figure 4

(A) Primary angioplasty forest plot. (B) Myocardial infarction with no obstructive coronary atherosclerosis (MINOCA) forest plot. (C) Stent implantation forest plot. (D) Baseline thrombus grade forest plot. (E) Modified thrombus grade forest plot. (F) Thrombus aspiration forest plot. (G) Glycoprotein IIbIIIa (Gp2b3a) inhibitor use forest plot. (H) Thrombolysis in myocardial infarction (TIMI)-3 flow forest plot.

Figure 5

(A) In-hospital mortality forest plot. (B) Cardiogenic shock forest plot. (C) Stent thrombosis forest plot. (D) Bleeding forest plot. (E) Intensive care unit (ICU) admission rate forest plot. (F) Length of stay forest plot (days).

Figure 6

(A) SO-to-FMC time funnel plot. (B) D2B time funnel plot.

Figure 7

(A) CRP funnel plot. (B) WBC funnel plot. (C) D-dimer funnel plot. (D) Lymphocyte count funnel plot.

Figure 8

(A) Primary angioplasty funnel plot. (B) MINOCA funnel plot. (C) Stent implantation funnel plot. (D) Baseline thrombus grade funnel plot. (E) Modified thrombus grade funnel plot. (F) Thrombus aspiration funnel plot. (G) Gp2b3a inhibitor use funnel plot. (H) TIMI-3 flow funnel plot.

Figure 9

(A) In-hospital mortality funnel plot. (B) Cardiogenic shock funnel plot. (C) Stent thrombosis funnel plot. (D) Bleeding funnel plot. (E) ICU admission rate funnel plot. (F) Length of stay funnel plot.