RESUMEN
AIMS: The aim of this study was to report the prevalence, clinical features and outcomes of patients with ST-elevation myocardial infarction (STEMI) hospitalized during the Corona-Virus Disease 2019 (COVID-19) outbreak compared with those admitted in a previous equivalent period. METHODS AND RESULTS: Eighty-five patients admitted for STEMI at a high-volume Italian centre were included. Patients hospitalized during the COVID-19 outbreak (21 February-10 April 2020) (40%) were compared with those admitted in pre-COVID-19 period (3 January-20 February 2020) (60%). A 43% reduction in STEMI admissions was observed during the COVID-19 outbreak compared with the previous period. Time from symptom onset to first medical contact (FMC) and time from FMC to primary percutaneous coronary intervention (PPCI) were longer in patients admitted during the COVID-19 period compared with before [148 (79-781) versus 130 (30-185) min; Pâ=â0.018, and 75 (59-148)] versus 45 (30-70) min; Pâ<â0.001]. High-sensitive troponin T levels on admission were also higher. In-hospital mortality was 12% in the COVID-19 phase versus 6% in the pre-COVID-19 period. Incidence of the composite end-point, including free-wall rupture, severe left ventricular dysfunction, left ventricular aneurysm, severe mitral regurgitation and pericardial effusion, was higher during the COVID-19 than the pre-COVID-19 period (19.6 versus 41.2%; Pâ=â0.030; odds ratioâ=â2.87; 95% confidence interval 1.09-7.58). CONCLUSION: The COVID-19 pandemic had a significant impact on the STEMI care system reducing hospital admissions and prolonging revascularization time. This translated into a worse patient prognosis due to more STEMI complications.
Asunto(s)
Infecciones por Coronavirus , Aneurisma Cardíaco , Rotura Cardíaca Posinfarto/epidemiología , Pandemias , Intervención Coronaria Percutánea , Derrame Pericárdico , Neumonía Viral , Infarto del Miocardio con Elevación del ST , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Femenino , Aneurisma Cardíaco/epidemiología , Aneurisma Cardíaco/etiología , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Pandemias/prevención & control , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/métodos , Derrame Pericárdico/epidemiología , Derrame Pericárdico/etiología , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Prevalencia , SARS-CoV-2 , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/mortalidad , Infarto del Miocardio con Elevación del ST/cirugía , Tiempo de Tratamiento/estadística & datos numéricosRESUMEN
A wide spectrum of cardiovascular manifestations has been documented in patients suffering from coronavirus disease-2019 (COVID-19). Usually associated with a poor prognoses, these manifestations include thromboembolic events, acute coronary syndrome, heart failure, and cardiogenic shock. We describe a patient with COVID-19 who presented with subacute myocardial infarction, biventricular thrombi, and bilateral pulmonary emboli. Biventricular thrombi are rare, and their presence raises concern for an underlying prothrombotic condition.