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. 2023 Jan 15:187:76-83.
doi: 10.1016/j.amjcard.2022.09.030. Epub 2022 Nov 29.

Mechanical Circulatory Support in Patients With COVID-19 Presenting With Myocardial Infarction

Raviteja R Guddeti  1 , Cristina Sanina  2 , Rajiv Jauhar  3 , Timothy D Henry  4 , Payam Dehghani  5 , Ross Garberich  1 , Christian W Schmidt  2 , Keshav R Nayak  6 , Jay S Shavadia  7 , Akshay Bagai  8 , Chadi Alraies  9 , Aditya Mehra  10 , Rodrigo Bagur  11 , Cindy Grines  12 , Avneet Singh  3 , Rajan A G Patel  13 , Wah Wah Htun  14 , Nima Ghasemzadeh  15 , Laura Davidson  16 , Deepak Acharya  17 , Ameer Kabour  18 , Abdul Moiz Hafiz  19 , Shy Amlani  20 , Hal S Wasserman  21 , Timothy Smith  4 , Navin K Kapur  22 , Santiago Garcia  23
Affiliations

Mechanical Circulatory Support in Patients With COVID-19 Presenting With Myocardial Infarction

Raviteja R Guddeti et al. Am J Cardiol. .

Abstract

ST-segment elevation myocardial infarction (STEMI) complicating COVID-19 is associated with an increased risk of cardiogenic shock and mortality. However, little is known about the frequency of use and clinical impact of mechanical circulatory support (MCS) in these patients. We sought to define patterns of MCS utilization, patient characteristics, and outcomes in patients with COVID-19 with STEMI. The NACMI (North American COVID-19 Myocardial Infarction) is an ongoing prospective, observational registry of patients with COVID-19 positive (COVID-19+) with STEMI with a contemporary control group of persons under investigation who subsequently tested negative for COVID-19 (COVID-19-). We compared the baseline characteristics and in-hospital outcomes of COVID-19+ and patients with COVID-19- according to the use of MCS. The primary outcome was a composite of in-hospital mortality, stroke, recurrent MI, and repeat unplanned revascularization. A total of 1,379 patients (586 COVID-19+ and 793 COVID-19-) enrolled in the NACMI registry between January 2020 and November 2021 were included in this analysis; overall, MCS use was 12.3% (12.1% [n = 71] COVID-19+/MCS positive [MCS+] vs 12.4% [n = 98] COVID-19-/MCS+). Baseline characteristics were similar between the 2 groups. The use of percutaneous coronary intervention was similar between the groups (84% vs 78%; p = 0.404). Intra-aortic balloon pump was the most frequently used MCS device in both groups (53% in COVID-19+/MCS+ and 75% in COVID-19-/MCS+). The primary outcome was significantly higher in COVID-19+/MCS+ patients (60% vs 30%; p = 0.001) because of very high in-hospital mortality (59% vs 28%; p = 0.001). In conclusion, patients with COVID-19+ with STEMI requiring MCS have very high in-hospital mortality, likely related to the significantly higher pulmonary involvement compared with patients with COVID-19- with STEMI requiring MCS.

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Figures

Figure 1
Figure 1
Flow chart showing patient inclusion.
Figure 2
Figure 2
Bar graph demonstrating frequency of use of various MCS devices stratified by COVID-19 status.
Figure 3
Figure 3
In-hospital outcomes, including composite outcome and its individual components, total length of hospital stay, and length of ICU stay. ICU = intensive care unit.
See this image and copyright information in PMC

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