Clinical characteristics and outcomes of patients presenting with acute myocardial infarction and cardiogenic shock during coronavirus disease 2019: An analysis from the national cardiogenic shock initiative

ABSTRACT

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has created challenges in the delivery of acute cardiovascular care. Here, we evaluate the clinical characteristics and outcomes of patients presenting with acute myocardial infarction and cardiogenic shock (AMICS) during the COVID-19 pandemic. Hypothesis: COVID-19 time period will associate with longer door to intervention times, and increased all-cause mortality among patients presenting with AMICS. Methods: Using the National Cardiogenic Shock Initiative database, we identified 406 patients who presented with AMICS. This group was divided into those who presented prior to COVID-19 (N=346, 5/9/2016-2/29/20) and those who presented during the pandemic (N=60, 3/1/20- 11/10/20). Clinical characteristics, treatment patterns, and outcomes were compared between the two groups. Results: The median age (25 -75 percentile) of the cohort was 64 (55-72) years, and 23.7% of the group was female. There were no significant differences in age, sex, and medical comorbidities between the two groups. Patients presenting during the pandemic were less likely to be of Black race, and more likely to be of Hispanic and White race than patients presenting prior to COVID-19. Median door to balloon (89.5 vs. 88 mins, p=0.38), door to support (88 vs. 78 mins, p=0.13), and onset of shock to support (73.5 vs. 62 mins, p=0.15) times were not significantly different when comparing those who presented prior to with those who presented during the pandemic. Rates of transfer from another hospital, and cardiac arrest prior to arrival in the cardiac catheterization lab were similar between the two groups. ST-Elevation Myocardial Infarction presentations were increased during the COVID-19 period (95% vs 80%, p=0.01). In adjusted logistic regression models, time period (during vs pre-COVID-19) did not significantly associate with survival to discharge (OR 1.17, 95% CI 0.59-2.35, p=0.65) or with one month survival (OR 0.82, 95% CI 0.42-1.61, p=0.56). Conclusions: Care of patients presenting with AMICS has remained robust among hospitals participating in the National Cardiogenic Shock Initiative during the COVID-19 pandemic. th th .