The impact of COVID-19 on clinical outcomes among acute myocardial infarction patients undergoing early invasive treatment strategy

Abstract

Background: The implications of coronavirus disease 2019 (COVID-19) infection on outcomes after invasive therapeutic strategies among patients presenting with acute myocardial infarction (AMI) are not well studied.

Hypothesis: To assess the outcomes of COVID-19 patients presenting with AMI undergoing an early invasive treatment strategy.

Methods: This study was a cross-sectional, retrospective analysis of the National COVID Cohort Collaborative database including all patients presenting with a recorded diagnosis of AMI (ST-elevation myocardial infarction (MI) and non-ST elevation MI). COVID-19 positive patients with AMI were stratified into one of four groups: (1a) patients who had a coronary angiogram with percutaneous coronary intervention (PCI) within 3 days of their AMI; (1b) PCI within 3 days of AMI with coronary artery bypass graft (CABG) within 30 days; (2a) coronary angiogram without PCI and without CABG within 30 days; and (2b) coronary angiogram with CABG within 30 days. The main outcomes were respiratory failure, cardiogenic shock, prolonged length of stay, rehospitalization, and death.

Results: There were 10 506 COVID-19 positive patients with a diagnosis of AMI. COVID-19 positive patients with PCI had 8.2 times higher odds of respiratory failure than COVID-19 negative patients (p = .001). The odds of prolonged length of stay were 1.7 times higher in COVID-19 patients who underwent PCI (p = .024) and 1.9 times higher in patients who underwent coronary angiogram followed by CABG (p = .001).

Conclusion: These data demonstrate that COVID-19 positive patients with AMI undergoing early invasive coronary angiography had worse outcomes than COVID-19 negative patients.

Keywords: COVID-19; cardiac catheterization; pediatric clinical cardiology; percutaneous coronary intervention.

Figure 1

CONSORT flow diagram of the study. Out of the 10 506 patients included in the study, 570, 202, 762, and 190 patients were included after propensity patching in the PCI, PCI with CABG, neither PCI nor CABG, and CABG groups respectively. The number of COVID‐positive patients in all groups are depicted in the last row. AMI, acute myocardial infarction; CABG, coronary artery bypass graft; COVID, coronavirus disease; N3C, National COVID Cohort Collaborative; PCI, percutaneous coronary intervention.

Figure 2

Odds of adverse outcomes in COVID‐19 positive versus negative subjects. The figure depicts the odds of respiratory failure, rehospitalization, long length of stay (LOS), death, and cardiogenic shock in COVID‐19 positive versus negative patients. COVID‐19‐positive patients who underwent PCI had higher odds of respiratory failure. The odds of prolonged length of stay were higher in COVID‐19 patients who underwent PCI and in patients who underwent CABG. CABG, coronary artery bypass graft; CI, confidence interval; COVID‐19, coronavirus disease 2019; PCI, percutaneous coronary intervention.