Consequences of COVID-19 pandemic on myocardial infarction reperfusion therapy and prognosis

Resumen

Background: The coronavirus disease (COVID-19) pandemic affected the prompt diagnosis and treatment of Acute myocardial infarction (AMI). Aim: To characterize the clinical profile of patients with AMI during the COVID-19 pandemic, comparing them with a historical cohort. Material and methods: A case-control study of 96 patients with AMI transferred to a high-volume percutaneous coronary intervention (PCI) hospital between March and July 2020, and a historical cohort of 269 patients transferred during the same period in 2019. Results: When comparing patients transferred during the pandemic with those of the historical cohort, the former were younger (63±12 and 68±12 years respectively, p<0.01), had a higher frequency of hypertension (66 and 45% respectively, p<0.01) and of smoking (40% vs 25%, p<0.01). Also, a higher proportion of patients during COVID had a ST-elevation AMI consulting >12 hours from the onset of symptoms (44 and 0% respectively, p<0.01), a higher median door-to-device time (4 and 3 hours respectively, p<0.01), a higher use of primary percutaneous coronary intervention (97 and 71% respectively, p<0.01), and higher frequencies of cardiogenic shock (20 and 4% respectively, p<0.01) and mechanical complications (10% and 2% respectively, p<0.01). Patients during COVID pandemic had a higher thirty-day overall (20 and 1.4% respectively, p<0.01) and cardiovascular mortality (13 and 1% respectively, p<0.01). During the outbreak, 40% of patients had positive COVID-19 status, which was a predictor for thirty-day overall mortality (Risk ratio 2.90; 95% confidence intervals 1.14-7.36). Conclusions: During the pandemic patients with AMI exhibited delays in consultations and treatment, higher morbidity, and increased mortality. COVID-19 positivity was associated to worse thirty-day overall survival.