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Patel S, Ballout M, Khan S, Robinson S, Adams AM, Rynarzewska A, Delzell JE. Patients With ST-Segment Elevation Myocardial Infarction and Cerebrovascular Accidents: Impact of COVID-19 Vaccination on Mortality. Cardiol Res 2024; 15:275-280. [PMID: 39205963 PMCID: PMC11349142 DOI: 10.14740/cr1688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) infection is associated with proinflammatory states and adverse health outcomes such as ST-segment elevation myocardial infarction (STEMI) and cerebrovascular accidents (CVA). Limited evidence suggests that COVID-19 vaccination may decrease the adverse impact of COVID-19 infections. This study was designed to determine if patients who received COVID-19 vaccination had lower mortality from STEMI and CVA. Methods This is a retrospective comparative analysis of 3,050 patients, who were admitted to the hospital and diagnosed with STEMI or CVA between April 1, 2019, and April 1, 2022. Patients were divided into three different timeframes: pre-COVID (April 1, 2019, to March 31, 2020), COVID (April 1, 2020 to March 31, 2021), and post-COVID (April 1, 2021 to March 31, 2022). Chi-square analysis was completed to analyze associations between STEMI, CVA, and vaccination status. A multinominal logistic regression was used to determine significant predictors for in-hospital mortality. Results A total of 3,050 patients were admitted (1,873 STEMI and 1,177 CVA). STEMI accounted for about 60% of cases in each of the three time periods. There was no statistical difference in STEMI or CVA percentages in the three time periods. There was increased mortality in STEMI and CVA patients (odds ratio (OR) = 11.4; P < 0.001), but patients who received the COVID-19 vaccine were less likely to die (OR = 0.51, 95% confidence interval (CI): 0.28 - 0.93; P < 0.027) when compared to those who were unvaccinated. There was increased risk of death in patients with atrial fibrillation (AFIB) (OR = 2.43; P < 0.001) and chronic heart failure (CHF) (OR = 1.76; P = 0.004). There was increased mortality risk associated with age (OR =1.03; P = 0.001). Patients with coronary artery disease (CAD) (OR = 0.45; P = 0.014) and hyperlipidemia (OR = 0.29; P < 0.001) were less likely to die. Conclusions Vaccination against COVID-19 was associated with reduced mortality rates in patients hospitalized with STEMI and CVA. Patients with pre-existing cardiovascular comorbidities such as CAD and hyperlipidemia also had lower mortality.
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Affiliation(s)
- Sharvil Patel
- Internal Medicine Department, Northeast Georgia Medical Center, Gainesville, GA, USA
| | - Mahmoud Ballout
- Internal Medicine Department, Northeast Georgia Medical Center, Gainesville, GA, USA
| | - Sandus Khan
- Internal Medicine Department, Northeast Georgia Medical Center, Gainesville, GA, USA
| | - Shane Robinson
- GME Research, Northeast Georgia Medical Center, Gainesville, GA, USA
| | - Alex M. Adams
- Cardiology Department, Northeast Georgia Medical Center, Gainesville, GA, USA
| | - Ania Rynarzewska
- GME Research, Georgia College and State University, Milledgeville, GA, USA
| | - John E. Delzell
- Department of Graduate Medical Education, Northeast Georgia Medical Center, Gainesville, GA, USA
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Bao Q, Li R, Wang C, Wang S, Cheng M, Pu C, Zou L, Liu C, Zhang Q, Wang Q. Differences in door-to-balloon time and outcomes in SARS-CoV-2-positive ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e35612. [PMID: 37832042 PMCID: PMC10578758 DOI: 10.1097/md.0000000000035612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 infection has significantly impacted the world and placed a heavy strain on the medical system and the public, especially those with cardiovascular diseases. Hoverer, the differences in door-to-balloon time and outcomes in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are not known too much. METHODS Web of Science, EMBASE, PubMed, Cochrane Library, Wanfang, VIP, and China's National Knowledge Infrastructure were utilized to perform a systematic literature search until April 30, 2023. We computed the odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) to determine the correlation. A random-effects model was used for the meta-analysis if the study had significant heterogeneity. Meanwhile, sensitivity analysis and Trial sequential analysis were also accomplished using Rveman5.4 and trial sequential analysis 0.9.5.10 Beta software, respectively. RESULTS A total of 5 eligible studies were explored in our meta-analysis, including 307 cases and 1804 controls. By meta-analysis, the pooled data showed that SARS-CoV-2-positive STEMI patients undergoing percutaneous coronary intervention had a longer door-to-balloon time (OR 6.31, 95% CI 0.99, 11.63, P = .02) than the negative subjects. The glycoprotein IIb/IIIa inhibitor use after SARS-CoV-2 infection (OR 2.71, 95% CI 1.53, 4.81, P = .0006) was relatively frequent compared with controls, and the postoperative Thrombolysis in Myocardial Infarction blood flow (OR 0.48, 95% CI 0.34, 0.67, P < .0001) was worse compared that. The in-hospital mortality (OR 5.16, 95% CI 3.53, 7.53, P < .00001) was higher than non-SARS-CoV-2 infection ones. In addition, we also discovered that age, gender (male), hypertension, diabetes mellitus, hyperlipidemia, smoking, previous myocardial infarction, total ischemia time, and thrombus aspiration use did not have a significant association with the development of STEMI patients with SARS-CoV-2. CONCLUSION SARS-CoV-2 positivity is significantly associated with longer door-to-balloon time and higher in-hospital mortality in STEMI patients undergoing primary percutaneous coronary intervention.
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Affiliation(s)
- Qinxue Bao
- Department of Cardiology, Dayi County People’s Hospital, Chengdu, Sichuan, China
| | - Rui Li
- Department of Cardiology, Dayi County People’s Hospital, Chengdu, Sichuan, China
| | - Chengfeng Wang
- Department of Cardiology, Dayi County People’s Hospital, Chengdu, Sichuan, China
| | - Shan Wang
- Department of Cardiology, Dayi County People’s Hospital, Chengdu, Sichuan, China
| | - Minli Cheng
- Department of Cardiology, Dayi County People’s Hospital, Chengdu, Sichuan, China
| | - Chunhua Pu
- Department of Cardiology, Dayi County People’s Hospital, Chengdu, Sichuan, China
| | - Lei Zou
- Department of Cardiology, Dayi County People’s Hospital, Chengdu, Sichuan, China
| | - Chao Liu
- Department of Cardiology, Dayi County People’s Hospital, Chengdu, Sichuan, China
| | - Qine Zhang
- Department of Cardiology, Dayi County People’s Hospital, Chengdu, Sichuan, China
| | - Qun Wang
- Department of Medical Laboratory, Dayi County People’s Hospital, Chengdu, Sichuan, China
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3
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Shaikh A, Khan SD, Baloch F, Virani SS, Samad Z. The COVID-19 Pandemic and Coronary Heart Disease: the Next Surge. Curr Atheroscler Rep 2023; 25:559-569. [PMID: 37531071 DOI: 10.1007/s11883-023-01131-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE OF REVIEW In this narrative review, we highlight different ways in which the COVID-19 pandemic has impacted coronary heart disease (CHD) burden and how a surge in morbidity and mortality may be expected in the near future. We also discuss potential solutions, and the direction subsequent research and corrective actions should take. RECENT FINDINGS COVID-19 has been implicated in the development and worsening of CHD via acute and chronic mechanisms in the form of plaque rupture, destabilization, and sustenance of a chronic inflammatory state leading to long COVID syndrome and increased rates of myocardial infarction. However, indirectly the pandemic is likely to further escalate the CHD burden through poor health behaviors such as tobacco consumption, reduced physical activity, economic devastation and its associated sequelae, and regular cardiac care interruptions and delays. COVID-19 has increased the total CHD burden and will require extensive resource allocation and multifaceted strategies to curb future rise.
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4
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Wada H, Shiraki K, Shimpo H, Shimaoka M, Iba T, Suzuki-Inoue K. Thrombotic Mechanism Involving Platelet Activation, Hypercoagulability and Hypofibrinolysis in Coronavirus Disease 2019. Int J Mol Sci 2023; 24:ijms24097975. [PMID: 37175680 PMCID: PMC10178520 DOI: 10.3390/ijms24097975] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has spread, with thrombotic complications being increasingly frequently reported. Although thrombosis is frequently complicated in septic patients, there are some differences in the thrombosis noted with COVID-19 and that noted with bacterial infections. The incidence (6-26%) of thrombosis varied among reports in patients with COVID-19; the incidences of venous thromboembolism and acute arterial thrombosis were 4.8-21.0% and 0.7-3.7%, respectively. Although disseminated intravascular coagulation (DIC) is frequently associated with bacterial infections, a few cases of DIC have been reported in association with COVID-19. Fibrin-related markers, such as D-dimer levels, are extremely high in bacterial infections, whereas soluble C-type lectin-like receptor 2 (sCLEC-2) levels are high in COVID-19, suggesting that hypercoagulable and hyperfibrinolytic states are predominant in bacterial infections, whereas hypercoagulable and hypofibrinolytic states with platelet activation are predominant in COVID-19. Marked platelet activation, hypercoagulability and hypofibrinolytic states may cause thrombosis in patients with COVID-19.
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Affiliation(s)
- Hideo Wada
- Department of General and Laboratory Medicine, Mie Prefectural General Medical Center, Yokkaichi 5450-132, Japan
| | - Katsuya Shiraki
- Department of General and Laboratory Medicine, Mie Prefectural General Medical Center, Yokkaichi 5450-132, Japan
| | - Hideto Shimpo
- Mie Prefectural General Medical Center, Yokkaichi 5450-132, Japan
| | - Motomu Shimaoka
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu 514-0001, Japan
| | - Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Katsue Suzuki-Inoue
- Department of Clinical and Laboratory Medicine, Yamanashi Medical University, Yamanashi 409-3821, Japan
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5
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McAlister FA, Hau JP, Atzema C, McRae AD, Morrison LJ, Grant L, Cheng I, Rosychuk RJ, Hohl CM. The burden of incidental SARS-CoV-2 infections in hospitalized patients across pandemic waves in Canada. Sci Rep 2023; 13:6635. [PMID: 37095174 PMCID: PMC10123574 DOI: 10.1038/s41598-023-33569-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/14/2023] [Indexed: 04/26/2023] Open
Abstract
Many health authorities differentiate hospitalizations in patients infected with SARS-CoV-2 as being "for COVID-19" (due to direct manifestations of SARS-CoV-2 infection) versus being an "incidental" finding in someone admitted for an unrelated condition. We conducted a retrospective cohort study of all SARS-CoV-2 infected patients hospitalized via 47 Canadian emergency departments, March 2020-July 2022 to determine whether hospitalizations with "incidental" SARS-CoV-2 infection are less of a burden to patients and the healthcare system. Using a priori standardized definitions applied to hospital discharge diagnoses in 14,290 patients, we characterized COVID-19 as (i) the "Direct" cause for the hospitalization (70%), (ii) a potential "Contributing" factor for the hospitalization (4%), or (iii) an "Incidental" finding that did not influence the need for admission (26%). The proportion of incidental SARS-CoV-2 infections rose from 10% in Wave 1 to 41% during the Omicron wave. Patients with COVID-19 as the direct cause of hospitalization exhibited significantly longer LOS (mean 13.8 versus 12.1 days), were more likely to require critical care (22% versus 11%), receive COVID-19-specific therapies (55% versus 19%), and die (17% versus 9%) compared to patients with Incidental SARS-CoV-2 infections. However, patients hospitalized with incidental SARS-CoV-2 infection still exhibited substantial morbidity/mortality and hospital resource use.
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Affiliation(s)
- Finlay A McAlister
- The Division of General Internal Medicine, Faculty of Medicine and Dentistry, University of Alberta, 5-134C Clinical Sciences Building, 11350 83 Avenue, Edmonton, AB, T6G 2G3, Canada.
- The Alberta Strategy for Patient Oriented Research Support Unit, Edmonton, Canada.
| | - Jeffrey P Hau
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Clare Atzema
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Andrew D McRae
- Department of Emergency Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Laurie J Morrison
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lars Grant
- Department of Emergency Medicine, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - Ivy Cheng
- Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rhonda J Rosychuk
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Corinne M Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
- Emergency Department, Vancouver General Hospital, Vancouver, BC, Canada
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6
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Cheema HA, Ehsan M, Ayyan M, Shahid A, Farooq M, Javed MU, Lak HM, Ahmad MQ, Virk HUH, Lakhter V, Lee KY. In-hospital mortality of COVID-19 patients hospitalized with ST-segment elevation myocardial infarction: A meta-analysis. IJC HEART & VASCULATURE 2022; 43:101151. [PMID: 36411872 PMCID: PMC9671642 DOI: 10.1016/j.ijcha.2022.101151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/27/2022] [Accepted: 11/16/2022] [Indexed: 11/18/2022]
Abstract
Introduction Coronavirus Disease 2019 (COVID-19) has been associated with an increased risk of adverse cardiovascular events including arteriovenous thrombosis, myocarditis and acute myocardial injury. Relevant literature to date has reported widely varying estimates of mortality, ranging from approximately 2 to 11 times higher odds of mortality in COVID-19-positive STEMI (ST-segment elevation myocardial infarction) patients. Hence, we conducted this meta-analysis to resolve these inconsistencies and assess the impact of COVID-19 infection on mortality and other clinical outcomes in patients presenting with STEMI. Methods This meta-analysis was registered in PROSPERO (CRD42021297458) and performed according to the Cochrane Handbook for Systematic Reviews of Interventions. PubMed and Embase were searched from inception to November 2021 (updated on April 2022) using a search strategy consisting of terms relating to COVID-19, STEMI, and mortality. Results We identified 435 studies through our initial search. After screening according to our eligibility criteria, a total of 11 studies were included. Compared with the non-COVID-19 STEMI patients, the in-hospital mortality rate was higher in COVID-19-positive STEMI patients. Similarly, the risk of cardiogenic shock was higher in the COVID-19-positive patients. Length of hospital stay was longer in STEMI patients with COVID-19. Conclusions Our study highlights the necessity for early evaluation of COVID-19 status in all STEMI patients followed by risk stratification, prompt reperfusion and more aggressive management of COVID-19-positive patients. Further research is needed to elucidate the mechanisms behind poorer prognosis in such patients.
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Affiliation(s)
| | - Muhammad Ehsan
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Muhammad Ayyan
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Abia Shahid
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Minaam Farooq
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Muhammad Usman Javed
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Hassan Mehmood Lak
- Section of Clinical Cardiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Malik Qistas Ahmad
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Hafeez Ul Hassan Virk
- Department of Cardiology, Adena Regional Medical Center, Chillicothe, OH, United States
| | - Vladimir Lakhter
- Cardiology Division, Department of Internal Medicine, Temple University Hospital, Philadelphia, PA, United States
| | - Ka Yiu Lee
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
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7
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Anghel L, Tudurachi BS, Leonte A, Sascău RA, Zota IM, Bazyani A, Tinică G, Stătescu C. The Challenge of High Coronary Thrombotic Events in Patients with ST-Segment Elevation Myocardial Infarction and COVID-19. J Clin Med 2022; 11:6542. [PMID: 36362770 PMCID: PMC9654578 DOI: 10.3390/jcm11216542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
The aim of this observational study was to describe the characteristics and outcomes of coronavirus disease 2019 (COVID-19)-positive patients with ST-segment elevation myocardial infarction (STEMI), with a special focus on factors associated with a high risk of coronary thrombosis and in-hospital mortality. Comparing the two groups of patients with STEMI separated according to the presence of SARS-CoV-2 infections, it was observed that COVID-19 patients were more likely to present with dyspnea (82.43% vs. 61.41%, p = 0.048) and cardiogenic shock (10.52% vs. 5.40%, p = 0.012). A longer total ischemia time was observed in COVID-19 patients, and they were twice as likely to undergo coronary angiography more than 12 hours after the onset of symptoms (19.29% vs. 10.13%, p = 0.024). In 10 of 57 COVID-19-positive patients, a primary PCI was not necessary, and only thromboaspiration was performed (17.54% vs. 2.70%, p < 0.001). Platelet level was inversely correlated (r = −0.512, p = 0.025) with a higher risk of coronary thrombosis without an atherosclerotic lesion. Using a cut-off value of 740 ng/ml, D-dimers predicted a higher risk of coronary thrombosis, with a sensitivity of 80% and a specificity of 66% (ROC area under the curve: 0.826, 95% CI: 0.716−0.935, p = 0.001). These are novel findings that raise the question of whether more aggressive antithrombotic therapy is necessary for selected COVID-19 and STEMI patients.
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Affiliation(s)
- Larisa Anghel
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania
| | - Bogdan-Sorin Tudurachi
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania
| | - Andreea Leonte
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania
| | - Radu Andy Sascău
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania
| | - Ioana Mădălina Zota
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania
| | - Amin Bazyani
- Interventional Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania
| | - Grigore Tinică
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiovascular Surgery Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania
| | - Cristian Stătescu
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania
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8
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Hu F, Zang M, Zheng L, Chen W, Guo J, Du Z, Liang E, Shen L, Hu X, Zheng D, Xu X, Hu G, Li A, Huang J, Yao Y, Pu J. Effect of COVID-19 Pandemic on Acute Coronary Syndrome Clinical Practice Patterns: Findings from a Multicenter Clinician Survey in China. Rev Cardiovasc Med 2022; 23:362. [PMID: 39076199 PMCID: PMC11269060 DOI: 10.31083/j.rcm2311362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/18/2022] [Accepted: 08/31/2022] [Indexed: 07/31/2024] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has severely affected healthcare systems around the world. This study aimed to investigate the perceptions of cardiologists regarding how the COVID-19 pandemic has affected the clinical practice patterns for acute coronary syndrome (ACS). Methods A multicenter clinician survey was sent to 300 cardiologists working in 22 provinces in China. The survey collected demographic information and inquired about their perceptions of how the COVID-19 pandemic has affected ACS clinical practice patterns. Results The survey was completed by 211 (70.3%) cardiologists, 82.5% of whom were employed in tertiary hospitals, and 52.1% reported more than 10 years of clinical cardiology practice. Most respondents observed a reduction in ACS inpatients and outpatients in their hospitals during the pandemic. Only 29.9% of the respondents had access to a dedicated catheter room for the treatment of COVID-19-positive ACS patients. Most respondents stated that the COVID-19 pandemic had varying degrees of effect on the treatment of acute ST-segment elevation myocardial infarction (STEMI), acute non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina. Compared with the assumed non-pandemic period, in the designed clinical questions, the selection of coronary interventional therapy for STEMI, NSTEMI, and unstable angina during the COVID-19 pandemic was significantly decreased (all p < 0.05), and the selection of pharmacotherapy was increased (all p < 0.05). The selection of fibrinolytic therapy for STEMI during the pandemic was higher than in the assumed non-pandemic period (p < 0.05). Conclusions The COVID-19 pandemic has profoundly affected ACS clinical practice patterns. The use of invasive therapies significantly decreased during the pandemic period, whereas pharmacotherapy was more often prescribed by the cardiologists.
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Affiliation(s)
- Feng Hu
- Department
of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University,
200030 Shanghai, China
| | - Minhua Zang
- Department
of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University,
200030 Shanghai, China
| | - Lihui Zheng
- Department of Cardiology, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences and Peking Union Medical College, 100730 Beijing, China
| | - Wensheng Chen
- Department of Cardiology, Guangdong Provincial Hospital of Chinese
Medicine, 510120 Guangzhou, Guangdong, China
| | - Jinrui Guo
- Department of Cardiology, Fuwai Yunnan Cardiovascular Hospital, 650102
Kunming, Yunnan, China
| | - Zhongpeng Du
- Department of Cardiology, Zhu Jiang Hospital of Southern Medical
University, 510260 Guangzhou, Guangdong, China
| | - Erpeng Liang
- Heart Center of Henan Provincial People's Hospital, Central China Fuwai
Hospital, Central China Fuwai Hospital of Zhengzhou University, 451460 Zhengzhou,
Henan, China
| | - Lishui Shen
- Department of Cardiology, Affiliated Hangzhou First People's Hospital,
Zhejiang University School of Medicine, 310030 Hangzhou, Zhejiang, China
| | - Xiaofeng Hu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong
University, 200030 Shanghai, China
| | - Dezhong Zheng
- Department of Cardiology, The Third Affiliated Hospital of Southern
Medical University, 510630 Guangzhou, Guangdong, China
| | - Xuelian Xu
- Department of Cardiology, University-Town Hospital of Chongqing Medical
University, 401331 Chongqing, China
| | - Gaifeng Hu
- Department of
Cardiology, The First Affiliated Hospital of Wenzhou Medical University, 325035
Wenzhou, Zhejiang, China
| | - Aihua Li
- Department of Cardiology, The Affiliated Hospital of Yangzhou University,
225003 Yangzhou, Jiangsu, China
| | - Jianfeng Huang
- Department
of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University,
200030 Shanghai, China
| | - Yan Yao
- Department of Cardiology, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences and Peking Union Medical College, 100730 Beijing, China
| | - Jun Pu
- Department
of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University,
200030 Shanghai, China
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9
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Simoni L, Alimehmeti I, Ceka A, Tafaj EA, Gina M, Panariti A, Xhafaj F, Dibra A, Goda A. Ongoing COVID-19 Pandemic Effects on Admissions and In-Hospital Outcomes in Patients With ST-Elevation Myocardial Infarction (STEMI): An Albanian Observational Study. Cureus 2022; 14:e26813. [PMID: 35971368 PMCID: PMC9374114 DOI: 10.7759/cureus.26813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 11/27/2022] Open
Abstract
Background Multiple studies conducted worldwide and in Albania documented an important reduction of acute ST-elevation myocardial infarction (STEMI) admissions during the Coronavirus Disease 19 (COVID-19) pandemic. There are few studies regarding STEMI admissions and outcomes during the ongoing pandemic after the initial lockdown. We aimed to study STEMI admissions and in-hospital outcomes after the COVID-19 lockdown period. Methods A retrospective single-center study was conducted, collecting data for all consecutive STEMI admissions from March 9th, (the first COVID-19 case) until April 30th, the corresponding period of 2020 total lockdown, for years 2019 and 2021. The control period was considered the year 2019 [pre-pandemic (PP)] and the study period was in 2021 [ongoing pandemic (OP)]. The incidence rate ratio (IRR) 95% confidence interval (CI) was used to compare all-STEMI admissions, invasive procedures, and risk ratio (RR) 95% CI to compare the mortality and complications rate between the study and control period. Results The study included 217 STEMI patients admitted in 2019, and 234 patients during the 2021 period. The overall-STEMI admissions IRR is in a similar range during the 2021 OP compared to the 2019 PP period IRR=1.07 (95%CI 0.90-1.28). Similar invasive procedures were observed during OP compared to PP period, respectively for coronary-angiography IRR= 1.07; (0.87-1.31), for all-PCI [1.12 (0.92-1.35)], and primary percutaneous coronary interventions (PCI) [1.09 (0.89-1.34)]. The STEMI death rate during OP compared to PP period was similar (7.3 vs. 7.4%), RR=1.01 (0.53-1.96), and a non-significant lower primary-PCI-death rate (4.0 vs 4.8%), RR= 0.83 (0.30-2.3)]. Conclusions After the initial reduction of admissions and invasive procedures in STEMI patients during the 2020 lockdown period and the increase of all-STEMI mortality, the number of hospitalizations, invasive procedures, and mortality returned to a similar range during OP compared to the PP period despite a highly incident ongoing COVID-19 pandemic.
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Affiliation(s)
- Leonard Simoni
- Cardiovascular Disease, University Hospital Center "Mother Teresa", Tirana, ALB
| | - Ilir Alimehmeti
- Health Commission, Academy of Sciences of Albania, Tirana, ALB
- Department of Family and Occupational Health, Faculty of Medicine, University of Medicine, Tirana, ALB
| | - Astrit Ceka
- Cardiovascular Disease, University Hospital Center Mother Teresa, Tirana, ALB
| | - Ermir A Tafaj
- Cardiovascular Disease, University Hospital Center "Mother Teresa", Tirana, ALB
| | - Mirald Gina
- Cardiovascular Disease, University Hospital Center "Mother Teresa", Tirana, ALB
| | - Aldo Panariti
- Cardiovascular Disease, University Hospital Center "Mother Teresa", Tirana, ALB
| | - Fatjon Xhafaj
- Cardiovascular Disease, University Hospital Center 'Mother Teresa", Tirana, ALB
| | - Alban Dibra
- Cardiovascular Disease, University Hospital Center "Mother Teresa", Tirana, ALB
| | - Artan Goda
- Cardiovascular Disease, University Hospital Center "Mother Teresa", Tirana, ALB
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