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Bhatt AS, Varshney AS, Goodrich EL, Gong J, Ginder C, Senman BC, Johnson M, Butler K, Woolley AE, de Lemos JA, Morrow DA, Bohula EA. Epidemiology and Management of ST-Segment-Elevation Myocardial Infarction in Patients With COVID-19: A Report From the American Heart Association COVID-19 Cardiovascular Disease Registry. J Am Heart Assoc 2022; 11:e024451. [PMID: 35470683 PMCID: PMC9238583 DOI: 10.1161/jaha.121.024451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Early reports from the COVID-19 pandemic identified coronary thrombosis leading to ST-segment-elevation myocardial infarction (STEMI) as a complication of COVID-19 infection. However, the epidemiology of STEMI in patients with COVID-19 is not well characterized. We sought to determine the incidence, diagnostic and therapeutic approaches, and outcomes in STEMI patients hospitalized for COVID-19. Methods and Results Patients with data on presentation ECG and in-hospital myocardial infarction were identified from January 14, 2020 to November 30, 2020, from 105 sites participating in the American Heart Association COVID-19 Cardiovascular Disease Registry. Patient characteristics, resource use, and clinical outcomes were summarized and compared based on the presence or absence of STEMI. Among 15 621 COVID-19 hospitalizations, 54 (0.35%) patients experienced in-hospital STEMI. Among patients with STEMI, the majority (n=40, 74%) underwent transthoracic echocardiography, but only half (n=27, 50%) underwent coronary angiography. Half of all patients with COVID-19 and STEMI (n=27, 50%) did not undergo any form of primary reperfusion therapy. Rates of all-cause shock (47% versus 14%), cardiac arrest (22% versus 4.8%), new heart failure (17% versus 1.4%), and need for new renal replacement therapy (11% versus 4.3%) were multifold higher in patients with STEMI compared with those without STEMI (P<0.050 for all). Rates of in-hospital death were 41% in patients with STEMI, compared with 16% in those without STEMI (P<0.001). Conclusions STEMI in hospitalized patients with COVID-19 is rare but associated with poor in-hospital outcomes. Rates of coronary angiography and primary reperfusion were low in this population of patients with STEMI and COVID-19. Adaptations of systems of care to ensure timely contemporary treatment for this population are needed.
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Affiliation(s)
- Ankeet S Bhatt
- Levine Cardiac Intensive Care Unit Thrombolysis in Myocardial Infarction (TIMI) Study Group Cardiovascular Division Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA
| | - Anubodh S Varshney
- Levine Cardiac Intensive Care Unit Thrombolysis in Myocardial Infarction (TIMI) Study Group Cardiovascular Division Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA
| | - Erica L Goodrich
- Levine Cardiac Intensive Care Unit Thrombolysis in Myocardial Infarction (TIMI) Study Group Cardiovascular Division Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA
| | - Jingyi Gong
- Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA
| | - Curtis Ginder
- Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA
| | - Balimkiz C Senman
- Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA
| | | | - Kayleigh Butler
- Levine Cardiac Intensive Care Unit Thrombolysis in Myocardial Infarction (TIMI) Study Group Cardiovascular Division Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA
| | - Ann E Woolley
- Division of Infectious Disease Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA
| | - James A de Lemos
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center and Parkland Health and Hospital System Dallas TX
| | - David A Morrow
- Levine Cardiac Intensive Care Unit Thrombolysis in Myocardial Infarction (TIMI) Study Group Cardiovascular Division Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA
| | - Erin A Bohula
- Levine Cardiac Intensive Care Unit Thrombolysis in Myocardial Infarction (TIMI) Study Group Cardiovascular Division Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA
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Varshney AS, Omar WA, Goodrich EL, Bhatt AS, Wolley AE, Gong J, Senman BC, Silva D, Levangie MW, Berg DD, Yeh RW, de Lemos JA, Morrow DA, Kazi DS, Bohula EA. Epidemiology of Cardiogenic Shock in Hospitalized Adults With COVID-19 : A Report From the American Heart Association COVID-19 Cardiovascular Disease Registry. Circ Heart Fail 2021; 14:e008477. [PMID: 34789004 DOI: 10.1161/circheartfailure.121.008477] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Anubodh S Varshney
- Levine Cardiac Intensive Care Unit, Thrombolysis in Myocardial Infarction Study Group, Cardiovascular Division, Department of Medicine, righam and Women's Hospital and Harvard Medical School, Boston, MA. (A.S.V., E.L.G., A.S.B., M.W.L., D.D.B., D.A.M., E.A.B.)
| | - Wally A Omar
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (W.A.O., R.W.Y., D.S.K.)
| | - Erica L Goodrich
- Levine Cardiac Intensive Care Unit, Thrombolysis in Myocardial Infarction Study Group, Cardiovascular Division, Department of Medicine, righam and Women's Hospital and Harvard Medical School, Boston, MA. (A.S.V., E.L.G., A.S.B., M.W.L., D.D.B., D.A.M., E.A.B.)
| | - Ankeet S Bhatt
- Levine Cardiac Intensive Care Unit, Thrombolysis in Myocardial Infarction Study Group, Cardiovascular Division, Department of Medicine, righam and Women's Hospital and Harvard Medical School, Boston, MA. (A.S.V., E.L.G., A.S.B., M.W.L., D.D.B., D.A.M., E.A.B.)
| | - Ann E Wolley
- Division of Infectious Disease, Department of Medicine, righam and Women's Hospital and Harvard Medical School, Boston, MA. (A.E.W.)
| | - Jingyi Gong
- Department of Medicine, righam and Women's Hospital and Harvard Medical School, Boston, MA. (J.G., B.C.S.)
| | - Balimkiz C Senman
- Department of Medicine, righam and Women's Hospital and Harvard Medical School, Boston, MA. (J.G., B.C.S.)
| | - Danuzia Silva
- University of Minnesota Medical School, Minneapolis (D.S.)
| | - Michael W Levangie
- Levine Cardiac Intensive Care Unit, Thrombolysis in Myocardial Infarction Study Group, Cardiovascular Division, Department of Medicine, righam and Women's Hospital and Harvard Medical School, Boston, MA. (A.S.V., E.L.G., A.S.B., M.W.L., D.D.B., D.A.M., E.A.B.)
| | - David D Berg
- Levine Cardiac Intensive Care Unit, Thrombolysis in Myocardial Infarction Study Group, Cardiovascular Division, Department of Medicine, righam and Women's Hospital and Harvard Medical School, Boston, MA. (A.S.V., E.L.G., A.S.B., M.W.L., D.D.B., D.A.M., E.A.B.)
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (W.A.O., R.W.Y., D.S.K.)
| | - James A de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center and Parkland Health and Hospital System, Dallas (J.A.d.L.)
| | - David A Morrow
- Levine Cardiac Intensive Care Unit, Thrombolysis in Myocardial Infarction Study Group, Cardiovascular Division, Department of Medicine, righam and Women's Hospital and Harvard Medical School, Boston, MA. (A.S.V., E.L.G., A.S.B., M.W.L., D.D.B., D.A.M., E.A.B.)
| | - Dhruv S Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (W.A.O., R.W.Y., D.S.K.)
| | - Erin A Bohula
- Levine Cardiac Intensive Care Unit, Thrombolysis in Myocardial Infarction Study Group, Cardiovascular Division, Department of Medicine, righam and Women's Hospital and Harvard Medical School, Boston, MA. (A.S.V., E.L.G., A.S.B., M.W.L., D.D.B., D.A.M., E.A.B.)
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