Covid-19 diagnosis and mortality in patients with non-ST-elevation myocardial infarction admitted in Italy during the national outbreak

Abstract

Introduction: We sought to assess the clinical impact of Covid-19 infection on mortality in patients with Non-ST elevation myocardial infarction (NSTEMI) admitted during the national outbreak in Italy.

Methods: We analysed a nationwide, comprehensive, and universal administrative database of consecutive NSTEMI patients admitted during lockdown for Covid-19 infection (March,11st - May 3rd, 2020) and the equivalent periods of the previous 5 years in Italy. The observed rate of 30-day and 6-month all-cause mortality of NSTEMI patients with and without Covid-19 infection during the lockdown was compared with the expected rate of death according to the trend of the previous 5 years.

Results: During the period of observation, 48.447 NSTEMI hospitalizations occurred in Italy. Among these, 4981 NSTEMI patients were admitted during the 2020 outbreak: 173 (3.5%) with and 4808 (96.5%) without a Covid-19 diagnosis. According to the 5-year trend, the 2020 expected rate of 30-day and 6-month all-cause mortality was 6.5% and 12.2%, while the observed incidence of death was 8.3% (p = 0.001) and 13.6% (p = 0.041), respectively. Excluding NSTEMI patients with a Covid-19 diagnosis, the 6-month mortality rate resulted in accordance with the prior 5-year trend. After multiple corrections, the presence of Covid-19 diagnosis resulted one of the independent predictors of all-cause mortality at 30 days [adjusted odds ratio (OR) 4.3; 95% confidence intervals (CI) 2.90-6.23; p < 0.0001] and 6 months (adjusted OR 3.5; 95% CI: 2.43-5.03; p < 0.0001).

Conclusions: During the 2020 national outbreak in Italy, a concomitant diagnosis of Covid-19 in NSTEMI was associated with a significantly higher rate of mortality.

Keywords: Acute coronary syndromes; Covid-19; National outbreak; Non-ST elevation myocardial infarction; Percutaneous coronary intervention.

Fig. 1

Expected (exp.) and observed (obs.) incidence of NSTEMI admission during the 2020 national outbreak and over the equivalent periods in the previous 5 years in Italy (panel A) and by geographic regions (panel B).

Fig. 2

Expected (exp.) and observed (obs.) mortality rate at 30 days (in the overall NSTEMI population and excluding those with Covid-19 infection) during the 2020 national outbreak and over the equivalent periods in the previous 5 years in Italy and by geographic regions.

Fig. 3

Expected (exp.) and observed (obs.) mortality rate at 6 months (in the overall NSTEMI population and excluding those with Covid-19 infection) during the 2020 national outbreak and over the equivalent periods in the previous 5 years in Italy and by geographic regions.