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1.
G Ital Cardiol (Rome) ; 23(3): 190-199, 2022 Mar.
Article in Italian | MEDLINE | ID: covidwho-1765603

ABSTRACT

Post-infarction mechanical complications include left ventricular free-wall rupture, ventricular septal rupture, and papillary muscle rupture. With the advent of early reperfusion strategies, including thrombolysis and percutaneous coronary intervention, these events now occur in fewer than 0.3% of patients following acute myocardial infarction. However, unfortunately, there has been no parallel decrease in associated mortality rates over the past two decades. Moreover, during the ongoing COVID-19 pandemic the incidence of mechanical complications resulting from ST-elevation myocardial infarction has possibly risen. Early diagnosis and prompt management are crucial to improving outcomes. Although some percutaneous device repair approaches are available, surgical treatment remains the gold standard for these catastrophic post-infarction complications. The timing of surgery, also related to the type of complication and patient's clinical conditions, and the possible role of mechanical circulatory supports before and after surgery, represent main topics of debate that still need to be fully addressed.


Subject(s)
COVID-19 , Myocardial Infarction , ST Elevation Myocardial Infarction , COVID-19/complications , Early Diagnosis , Humans , Myocardial Infarction/complications , Myocardial Infarction/diagnosis , Myocardial Infarction/therapy , Pandemics , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/therapy
4.
JAMA ; 326(19): 1940-1952, 2021 Nov 16.
Article in English | MEDLINE | ID: covidwho-1544160

ABSTRACT

IMPORTANCE: There has been limited research on patients with ST-segment elevation myocardial infarction (STEMI) and COVID-19. OBJECTIVE: To compare characteristics, treatment, and outcomes of patients with STEMI with vs without COVID-19 infection. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of consecutive adult patients admitted between January 2019 and December 2020 (end of follow-up in January 2021) with out-of-hospital or in-hospital STEMI at 509 US centers in the Vizient Clinical Database (N = 80 449). EXPOSURES: Active COVID-19 infection present during the same encounter. MAIN OUTCOMES AND MEASURES: The primary outcome was in-hospital mortality. Patients were propensity matched on the likelihood of COVID-19 diagnosis. In the main analysis, patients with COVID-19 were compared with those without COVID-19 during the previous calendar year. RESULTS: The out-of-hospital STEMI group included 76 434 patients (551 with COVID-19 vs 2755 without COVID-19 after matching) from 370 centers (64.1% aged 51-74 years; 70.3% men). The in-hospital STEMI group included 4015 patients (252 with COVID-19 vs 756 without COVID-19 after matching) from 353 centers (58.3% aged 51-74 years; 60.7% men). In patients with out-of-hospital STEMI, there was no significant difference in the likelihood of undergoing primary percutaneous coronary intervention by COVID-19 status; patients with in-hospital STEMI and COVID-19 were significantly less likely to undergo invasive diagnostic or therapeutic coronary procedures than those without COVID-19. Among patients with out-of-hospital STEMI and COVID-19 vs out-of-hospital STEMI without COVID-19, the rates of in-hospital mortality were 15.2% vs 11.2% (absolute difference, 4.1% [95% CI, 1.1%-7.0%]; P = .007). Among patients with in-hospital STEMI and COVID-19 vs in-hospital STEMI without COVID-19, the rates of in-hospital mortality were 78.5% vs 46.1% (absolute difference, 32.4% [95% CI, 29.0%-35.9%]; P < .001). CONCLUSIONS AND RELEVANCE: Among patients with out-of-hospital or in-hospital STEMI, a concomitant diagnosis of COVID-19 was significantly associated with higher rates of in-hospital mortality compared with patients without a diagnosis of COVID-19 from the past year. Further research is required to understand the potential mechanisms underlying this association.


Subject(s)
COVID-19/complications , Hospital Mortality , Hospitalization , ST Elevation Myocardial Infarction/mortality , Adult , Aged , Aged, 80 and over , Case-Control Studies , Databases, Factual , Female , Humans , Male , Middle Aged , Out-of-Hospital Cardiac Arrest , Propensity Score , Retrospective Studies , ST Elevation Myocardial Infarction/complications , United States/epidemiology
5.
JNMA J Nepal Med Assoc ; 59(242): 1048-1051, 2021 Oct 15.
Article in English | MEDLINE | ID: covidwho-1547958

ABSTRACT

Silent myocardial infarction or unrecognized myocardial infarction has increased prevalence in elderly population with increased cardiovascular risk factors. However, its prevalence in COVID-19 patients is not well-known. A 77-year-old Caucasian male with COVID-19 pneumonia, presented with silent ST-segment elevation myocardial infarction, diabetic ketoacidosis and multiorgan failure. He underwent cardiac catheterization and drug eluting stent placement in the ostial right coronary artery with safety protocol. He was discharged to extended-care-facility in stable condition. This is a first case report of silent ST-segment elevation myocardial infarction in a patient presenting with COVID-19. In patients with COVID-19, acute myocardial infarction should be ruled out even when asymptomatic, especially in older patients. Prompt intervention using safety protocol is life-saving.


Subject(s)
COVID-19 , Drug-Eluting Stents , Myocardial Infarction , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Aged , Humans , Male , Myocardial Infarction/complications , Myocardial Infarction/diagnosis , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/methods , SARS-CoV-2 , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/surgery , Treatment Outcome
6.
ESC Heart Fail ; 9(1): 775-781, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1516730

ABSTRACT

We present two cases of acute myocardial infarction in young patients with asymptomatic COVID-19 infection and ST-elevation myocardial infarction (STEMI), complicated by severe acute heart failure and ventricular fibrillation, resulting cardiopulmonary resuscitation and mechanical ventilatory support. Urgent primary percutaneous coronary intervention with further complex treatment was effective in both cases with critical cardiovascular state and co-morbid COVID-19 infection. This report illustrates the challenges in clinical severity of STEMI with COVID-19 infection, despite of young age and absence of clinical symptoms and chronic co-morbidities. STEMI patients with even asymptomatic COVID-19 infection may be presented with significantly higher rates of severe acute heart failure.


Subject(s)
COVID-19 , Myocardial Infarction , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Humans , SARS-CoV-2 , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/diagnosis , Young Adult
7.
JAMA ; 326(19): 1940-1952, 2021 Nov 16.
Article in English | MEDLINE | ID: covidwho-1490623

ABSTRACT

IMPORTANCE: There has been limited research on patients with ST-segment elevation myocardial infarction (STEMI) and COVID-19. OBJECTIVE: To compare characteristics, treatment, and outcomes of patients with STEMI with vs without COVID-19 infection. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of consecutive adult patients admitted between January 2019 and December 2020 (end of follow-up in January 2021) with out-of-hospital or in-hospital STEMI at 509 US centers in the Vizient Clinical Database (N = 80 449). EXPOSURES: Active COVID-19 infection present during the same encounter. MAIN OUTCOMES AND MEASURES: The primary outcome was in-hospital mortality. Patients were propensity matched on the likelihood of COVID-19 diagnosis. In the main analysis, patients with COVID-19 were compared with those without COVID-19 during the previous calendar year. RESULTS: The out-of-hospital STEMI group included 76 434 patients (551 with COVID-19 vs 2755 without COVID-19 after matching) from 370 centers (64.1% aged 51-74 years; 70.3% men). The in-hospital STEMI group included 4015 patients (252 with COVID-19 vs 756 without COVID-19 after matching) from 353 centers (58.3% aged 51-74 years; 60.7% men). In patients with out-of-hospital STEMI, there was no significant difference in the likelihood of undergoing primary percutaneous coronary intervention by COVID-19 status; patients with in-hospital STEMI and COVID-19 were significantly less likely to undergo invasive diagnostic or therapeutic coronary procedures than those without COVID-19. Among patients with out-of-hospital STEMI and COVID-19 vs out-of-hospital STEMI without COVID-19, the rates of in-hospital mortality were 15.2% vs 11.2% (absolute difference, 4.1% [95% CI, 1.1%-7.0%]; P = .007). Among patients with in-hospital STEMI and COVID-19 vs in-hospital STEMI without COVID-19, the rates of in-hospital mortality were 78.5% vs 46.1% (absolute difference, 32.4% [95% CI, 29.0%-35.9%]; P < .001). CONCLUSIONS AND RELEVANCE: Among patients with out-of-hospital or in-hospital STEMI, a concomitant diagnosis of COVID-19 was significantly associated with higher rates of in-hospital mortality compared with patients without a diagnosis of COVID-19 from the past year. Further research is required to understand the potential mechanisms underlying this association.


Subject(s)
COVID-19/complications , Hospital Mortality , Hospitalization , ST Elevation Myocardial Infarction/mortality , Adult , Aged , Aged, 80 and over , Case-Control Studies , Databases, Factual , Female , Humans , Male , Middle Aged , Out-of-Hospital Cardiac Arrest , Propensity Score , Retrospective Studies , ST Elevation Myocardial Infarction/complications , United States/epidemiology
9.
Tex Heart Inst J ; 48(3)2021 07 01.
Article in English | MEDLINE | ID: covidwho-1355273

ABSTRACT

During the coronavirus disease 2019 (COVID-19) pandmic, more patients are presenting with complications late after acute myocardial infarction. We report the case of a 71-year-old man who delayed seeking medical care for 2 weeks, despite progressive shortness of breath, cough, and tactile fever, for fear of contracting COVID-19 in the hospital. Clinical and echocardiographic evaluation revealed a ventricular septal rupture secondary to acute myocardial infarction. The patient underwent urgent cardiac catheterization, followed by successful saphenous vein grafting to the left anterior descending coronary artery and open surgical repair of the ventricular septal rupture with a bovine pericardial patch. This case highlights a potential long-lasting negative effect that the COVID-19 pandemic will have on the care-seeking behavior and health of patients with acute cardiovascular disease.


Subject(s)
COVID-19 , Cardiac Catheterization/methods , Coronary Artery Bypass/methods , Fear , Patient Acceptance of Health Care/psychology , ST Elevation Myocardial Infarction , Ventricular Septal Rupture , Aged , COVID-19/epidemiology , COVID-19/psychology , Coronary Angiography/methods , Echocardiography/methods , Electrocardiography/methods , Humans , Male , SARS-CoV-2 , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/physiopathology , ST Elevation Myocardial Infarction/surgery , Time-to-Treatment/trends , Treatment Outcome , Ventricular Septal Rupture/diagnosis , Ventricular Septal Rupture/etiology , Ventricular Septal Rupture/physiopathology , Ventricular Septal Rupture/surgery
10.
J Investig Med High Impact Case Rep ; 9: 23247096211031135, 2021.
Article in English | MEDLINE | ID: covidwho-1309898

ABSTRACT

Amid the coronavirus disease 2019 (COVID-19) pandemic, there is an unprecedented increase in public avoidance of hospitals predominantly driven by fear of contracting the virus. Recent publications highlight a re-emergence of rare post-myocardial infarction complications. While mechanical complications are infrequent in the era of primary percutaneous coronary intervention, they are associated with high mortality rates. The concurrent occurrence of mechanical complications such as left ventricular aneurysm and ventricular septal rupture is an extremely rare entity. We hereby delineate a unique case of a 53-year-old Caucasian male who underwent successful concomitant closure of a ventricular septal rupture, left ventricular aneurysmectomy, and 3-vessel coronary artery bypass grafting. Due to a delayed initial presentation owing to the patient's fear of contracting COVID-19, the surgery was carried out 3 months after the myocardial infarction. His postoperative evaluation confirmed normal contractility of the left ventricle and complete closure of the ventricular septal rupture. Six months postoperatively, the patient continues to do well. We also present a literature review of the mechanical complications following delayed presentation of myocardial infarction amid the COVID-19 pandemic. This article illustrates that clinicians should remain cognizant of these extremely rare but potentially lethal collateral effects during the ongoing global public-health challenge. Furthermore, it highlights a significant concern regarding the delay in first medical contact due to the reluctance of patients to visit the hospital during the COVID-19 pandemic.


Subject(s)
Heart Aneurysm/surgery , ST Elevation Myocardial Infarction/surgery , Time-to-Treatment , Ventricular Septal Rupture/surgery , COVID-19 , Cardiac Surgical Procedures , Coronary Artery Bypass , Heart Aneurysm/complications , Humans , Male , Middle Aged , ST Elevation Myocardial Infarction/complications , Treatment Outcome , Ventricular Septal Rupture/complications
11.
J Cardiothorac Surg ; 16(1): 106, 2021 Apr 22.
Article in English | MEDLINE | ID: covidwho-1199920

ABSTRACT

BACKGROUND: Left ventricular free wall rupture (LVFWR) is a rare complication after myocardial infarction and usually occurs 1 to 4 days after the infarct. Over the past decade, the overall incidence of LVFWR has decreased given the advancements in reperfusion therapies. However, during the COVID-19 pandemic, there has been a significant delay in hospital presentation of patients suffering myocardial infarctions, leading to a higher incidence of mechanical complications from myocardial infarctions such as LVFWR. CASE PRESENTATION: We present a case in which a patient suffered a LVFWR as a mechanical complication from myocardial infarction due to delay in seeking care over fear of contracting COVID-19 from the medical setting. The patient had been having chest pain for a few days but refused to seek medical care due to fear of contracting COVID-19 from within the medical setting. He eventually suffered a cardiac arrest at home from a massive inferior myocardial infarction and found to be in cardiac tamponade from a left ventricular perforation. He was emergently taken to the operating room to attempt to repair the rupture but he ultimately expired on the operating table. CONCLUSIONS: The occurrence of LVFWR has been on a more significant rise over the course of the COVID-19 pandemic as patients delay seeking care over fear of contracting COVID-19 from within the medical setting. Clinicians should consider mechanical complications of MI when patients present as an out-of-hospital cardiac arrest, particularly during the COVID-19 pandemic, as delay in seeking care is often the exacerbating factor.


Subject(s)
COVID-19/epidemiology , Heart Rupture/etiology , ST Elevation Myocardial Infarction/complications , Aged , Comorbidity , Computed Tomography Angiography , Echocardiography, Transesophageal , Electrocardiography , Heart Rupture/diagnosis , Heart Ventricles , Humans , Male , Pandemics , Radiography, Thoracic , SARS-CoV-2 , ST Elevation Myocardial Infarction/epidemiology
12.
Arch Cardiovasc Dis ; 114(5): 340-351, 2021 May.
Article in English | MEDLINE | ID: covidwho-1184770

ABSTRACT

BACKGROUND: Systems of care have been challenged to control progression of the COVID-19 pandemic. Whether this has been associated with delayed reperfusion and worse outcomes in French patients with ST-segment elevation myocardial infarction (STEMI) is unknown. AIM: To compare the rate of STEMI admissions, treatment delays, and outcomes between the first peak of the COVID-19 pandemic in France and the equivalent period in 2019. METHODS: In this nationwide French survey, data from consecutive STEMI patients from 65 centres referred for urgent revascularization between 1 March and 31 May 2020, and between 1 March and 31 May 2019, were analysed. The primary outcome was a composite of in-hospital death or non-fatal mechanical complications of acute myocardial infarction. RESULTS: A total of 6306 patients were included. During the pandemic peak, a 13.9±6.6% (P=0.003) decrease in STEMI admissions per week was observed. Delays between symptom onset and percutaneous coronary intervention were longer in 2020 versus 2019 (270 [interquartile range 150-705] vs 245 [140-646]min; P=0.013), driven by the increase in time from symptom onset to first medical contact (121 [60-360] vs 150 [62-420]min; P=0.002). During 2020, a greater number of mechanical complications was observed (0.9% vs 1.7%; P=0.029) leading to a significant difference in the primary outcome (112 patients [5.6%] in 2019 vs 129 [7.6%] in 2020; P=0.018). No significant difference was observed in rates of orotracheal intubation, in-hospital cardiac arrest, ventricular arrhythmias and cardiogenic shock. CONCLUSIONS: During the first peak of the COVID-19 pandemic in France, there was a decrease in STEMI admissions, associated with longer ischaemic time, exclusively driven by an increase in patient-related delays and an increase in mechanical complications. These findings suggest the need to encourage the population to seek medical help in case of symptoms.


Subject(s)
COVID-19/epidemiology , Pandemics , ST Elevation Myocardial Infarction/therapy , Comorbidity , Diabetes Mellitus/epidemiology , Female , France/epidemiology , Health Care Surveys , Heart Rupture, Post-Infarction/epidemiology , Hospital Mortality , Humans , Hyperlipidemias/epidemiology , Hypertension/epidemiology , Male , Middle Aged , Patient Acceptance of Health Care , Patient Admission/statistics & numerical data , Percutaneous Coronary Intervention/statistics & numerical data , Procedures and Techniques Utilization , Prognosis , Risk Factors , SARS-CoV-2 , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/epidemiology , Smoking/epidemiology , Stents , Time-to-Treatment , Treatment Outcome
13.
Am J Physiol Heart Circ Physiol ; 320(6): H2240-H2254, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1180981

ABSTRACT

The outbreak of severe acute respiratory syndrome coronavirus 2 that first emerged in Wuhan in December 2019 has resulted in the devastating pandemic of coronavirus disease 2019, creating an emerging need for knowledge sharing. Meanwhile, myocardial infarction is and will probably remain the foremost cause of death in the Western world throughout the coming decades. Severe deregulation of the immune system can unnecessarily expand the inflammatory response and participate in target and multiple organ failure, in infection but also in critical illness. Indeed, the course and fate of inflammatory cells observed in severe ST-elevation myocardial infarction (neutrophilia, monocytosis, and lymphopenia) almost perfectly mirror those recently reported in severe coronavirus disease 2019. A pleiotropic proinflammatory imbalance hampers adaptive immunity in favor of uncontrolled innate immunity and is associated with poorer structural and clinical outcomes. The goal of the present review is to gain greater insight into the cellular and molecular mechanisms underlying this canonical activation and downregulation of the two arms of the immune response in both entities, to better understand their pathophysiology and to open the door to innovative therapeutic options. Knowledge sharing can pave the way for therapies with the potential to significantly reduce mortality in both infectious and noninfectious scenarios.


Subject(s)
COVID-19/immunology , Immune System/physiopathology , ST Elevation Myocardial Infarction/immunology , COVID-19/complications , Humans , Inflammation/etiology , Inflammation/therapy , Myocardial Infarction/etiology , ST Elevation Myocardial Infarction/complications
14.
Mil Med ; 186(9-10): e1053-e1057, 2021 08 28.
Article in English | MEDLINE | ID: covidwho-1135872

ABSTRACT

We report the case of a 52-year-old white male who was recently diagnosed with symptomatic coronavirus disease-2019 (COVID-19) and presented to the hospital with ventricular tachycardia/ventricular fibrillation cardiac arrest, ST elevation myocardial infarction, and profound hypokalemia. The patient was successfully treated with primary percutaneous coronary intervention and concurrent aggressive potassium repletion. To the authors' knowledge, this is the first case of COVID-19 presenting not only with an acute coronary thrombosis but also severe hypokalemia, both of which contributed to his cardiac arrest. The association of COVID-19 with acute coronary thrombosis, including the challenges surrounding the diagnosis and management in this patient population, is discussed. Additionally, the effect of COVID-19 on the renin-angiotensin-aldosterone system is reviewed with a focus on hypokalemic presentations.


Subject(s)
COVID-19 , Coronary Thrombosis , Hypokalemia , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Humans , Hypokalemia/complications , Male , Middle Aged , SARS-CoV-2 , ST Elevation Myocardial Infarction/complications
15.
IEEE J Biomed Health Inform ; 25(4): 903-908, 2021 04.
Article in English | MEDLINE | ID: covidwho-1087889

ABSTRACT

Because of the rapid and serious nature of acute cardiovascular disease (CVD) especially ST segment elevation myocardial infarction (STEMI), a leading cause of death worldwide, prompt diagnosis and treatment is of crucial importance to reduce both mortality and morbidity. During a pandemic such as coronavirus disease-2019 (COVID-19), it is critical to balance cardiovascular emergencies with infectious risk. In this work, we recommend using wearable device based mobile health (mHealth) as an early screening and real-time monitoring tool to address this balance and facilitate remote monitoring to tackle this unprecedented challenge. This recommendation may help to improve the efficiency and effectiveness of acute CVD patient management while reducing infection risk.


Subject(s)
COVID-19/prevention & control , Cardiovascular Diseases/diagnosis , Monitoring, Ambulatory/instrumentation , Monitoring, Ambulatory/methods , Pandemics , SARS-CoV-2 , Telemedicine , Wearable Electronic Devices , Acute Disease , COVID-19/complications , COVID-19/epidemiology , Cardiovascular Diseases/complications , Cardiovascular Diseases/therapy , Humans , Risk Factors , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/therapy
16.
Heart Lung ; 50(2): 292-295, 2021.
Article in English | MEDLINE | ID: covidwho-1065104

ABSTRACT

The COVID 19 pandemic resulted in a total reduction in the number of hospitalizations for acute coronary syndromes. A consequence of the delay in coronary revascularization has been the resurgence of structural complications of myocardial infarctions. Ventricular septal rupture (VSR) complicating late presenting acute myocardial infarction (AMI) is associated with high mortality despite advances in both surgical repair and perioperative management. Current data suggests a declining mortality with delay in VSR repair; however, these patients may develop cardiogenic shock while waiting for surgery. Available options are limited for patients with VSR who develop right ventricular failure and cardiogenic shock. The survival rate is very low in patients with cardiogenic shock undergoing surgical or percutaneous VSR repair. In this study we present two late presenting ST elevation MI patients who were complicated by rapidly declining hemodynamics and impending organ failure. Both patients were bridged with venoarterial extracorporeal membrane oxygenation (ECMO) to cardiac transplant.


Subject(s)
COVID-19 , ST Elevation Myocardial Infarction , Ventricular Septal Rupture , Humans , Pandemics , SARS-CoV-2 , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/surgery , Shock, Cardiogenic/etiology , Treatment Outcome , Ventricular Septal Rupture/diagnosis , Ventricular Septal Rupture/epidemiology , Ventricular Septal Rupture/etiology
17.
Multimed Man Cardiothorac Surg ; 20202020 Dec 23.
Article in English | MEDLINE | ID: covidwho-1007098

ABSTRACT

We describe the insertion of the Impella 5.0, a peripherally placed mechanical cardiovascular microaxial pump, in a patient with ischemic left ventricular dysfunction. The Impella is a 7 Fr device capable of achieving a flow of 4.0-5.0 L/min; its use necessitates an open arterial cut-down. A subclavicular incision is used to access the right or left axillary artery. A 10-mm tube graft is anastomosed to the artery through which the Impella 5.0 is inserted. The device traverses the tube graft and is advanced via the aorta, across the aortic valve, to its final position (inflow toward the ventricular apex and outflow above the aorta). The device may remain in situ for 10 days until recovery or until further supports are instituted. Our goal is to demonstrate the insertion of the Impella 5.0 device in a patient with cardiogenic shock whose situation was further complicated by coronavirus disease 2019.


Subject(s)
Assisted Circulation , COVID-19 , Heart-Assist Devices , Prosthesis Implantation , ST Elevation Myocardial Infarction , Shock, Cardiogenic , Adult , Assisted Circulation/instrumentation , Assisted Circulation/methods , COVID-19/complications , COVID-19/therapy , Cardiac Catheterization/methods , Humans , Male , Prone Position/physiology , Prosthesis Implantation/instrumentation , Prosthesis Implantation/methods , SARS-CoV-2/isolation & purification , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/physiopathology , Shock, Cardiogenic/etiology , Shock, Cardiogenic/physiopathology , Shock, Cardiogenic/surgery , Treatment Outcome
18.
Am J Cardiol ; 144: 8-12, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1002270

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has greatly impacted the US healthcare system. Cardiac involvement in COVID-19 is common and manifested by troponin and natriuretic peptide elevation and tends to have a worse prognosis. We analyzed patients who presented to the MedStar Health system (11 hospitals in Washington, DC, and Maryland) with either an ST-elevation myocardial infarction or non-ST-elevation myocardial infarction early in the pandemic (March 1, 2020 to June 30, 2020) using the International Classification of Diseases, Tenth Revision. Patients' clinical course and outcomes, including in-hospital mortality, were compared on the basis of the results of COVID-19 status (positive or negative). The cohort included 1533 patients admitted with an acute myocardial infarction (AMI), of whom 86 had confirmed severe acute respiratory syndrome coronavirus 2 infection, during the study period. COVID-19-positive patients were older and non-White and had more co-morbidities. Furthermore, inflammatory markers and N-terminal-proB-type-natriuretic peptide were higher in COVID-19-positive AMI patients. Only 20.0% (17) of COVID-19-positive patients underwent coronary angiography. In-hospital mortality was significantly higher in AMI patients with concomitant COVID-19-positive status (27.9%) than in patients without COVID-19 during the same period (3.7%; p < 0.001). Patients with AMI and COVID-19 tended to be older, with more co-morbidities, when compared to those with an AMI and without COVID-19. In conclusion, myocardial infarction with concomitant COVID-19 was associated with increased in-hospital mortality. Efforts should be focused on the early recognition, evaluation, and treatment of these patients.


Subject(s)
COVID-19/complications , Myocardial Infarction/complications , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/mortality , Female , Hospital Mortality , Humans , Male , Middle Aged , Myocardial Infarction/diagnosis , Myocardial Infarction/mortality , Retrospective Studies , ST Elevation Myocardial Infarction/complications
20.
Ann Cardiol Angeiol (Paris) ; 69(6): 355-359, 2020 Dec.
Article in French | MEDLINE | ID: covidwho-935391

ABSTRACT

The COVID-19 pandemic had an unexpected impact on cardiovascular emergencies, particularly STEMI. The France PCI registry and other studies around the world have highlighted a significant decrease in myocardial infarctions arriving at hospital. This decrease is mainly related to patients' fear of coming to the hospital and being contaminated. Although the STEMI revascularisation time targets (<120min) are often difficult to achieve in normal times, they were almost impossible to achieve in periods of lockdown because of the many obstacles. Longer delays and longer total ischemic time have led to excess mortality, especially in the regions most affected by the epidemic. Recommendations for the management of STEMI during the COVID-19 period have thus been issued by the scientific societies. STEMI in patients with COVID-19 often have an uncommon clinical presentation, and the absence of coronary obstruction on angiography is frequent. Their prognosis is very poor. Only public information campaigns and an organisation adapted to the management of coronary emergencies during epidemics can try to limit their effects and avoid aggravating an already fragile health situation in the future.


Subject(s)
COVID-19 , ST Elevation Myocardial Infarction/therapy , COVID-19/complications , COVID-19/epidemiology , France/epidemiology , Humans , ST Elevation Myocardial Infarction/complications
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