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.
ABSTRACT
Background: Previous meta-analyses have focused on investigating the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on outcomes in STEMI patients. We aimed to examine the outcomes and prognosis following ST-segment elevation myocardial infarction (STEMI) among those with COVID-19 compared with those without COVID-19. Methods: PubMed and Embase were searched from inception till November 2021. We included only those studies that compared our primary outcome, in-hospital mortality, between COVID-19-positive and COVID-19-negative cohorts with primarily out-of-hospital STEMI. We conducted a random-effects meta-analysis to investigate the association between COVID-19 infection and mortality as well as other clinical outcomes. Results: A total of 11 observational studies were included in our meta-analysis. Most of the studies were of sufficiently high quality. Our findings show that a diagnosis of COVID-19 in STEMI patients is associated with a large increase in mortality (OR 4.07;95% CI: 2.48-6.69) and poorer clinical outcomes but with no increase in door-to-balloon (D2B) time (MD 9.45 minutes, 95% CI: -1.25 to 20.15 minutes). Conclusions: In this meta-analysis, a diagnosis of COVID-19 was found to greatly increase the risk of mortality. An early assessment of COVID-19 status in STEMI patients is needed followed by urgent management.