Increased mortality and worse cardiac outcome of acute myocardial infarction during the early COVID‐19 pandemic
Abstract Aims This study aimed to evaluate the impact of coronavirus disease 2019 (Covid‐19) outbreak on admissions for acute myocardial infarction (AMI) and related mortality, severity of presentation, major cardiac complications and outcome in a tertiary‐care university hospital in Berlin, Germany...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-02-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.13075 |
| _version_ | 1818933925192400896 |
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| author | Uwe Primessnig Burkert M. Pieske Mohammad Sherif |
| author_facet | Uwe Primessnig Burkert M. Pieske Mohammad Sherif |
| author_sort | Uwe Primessnig |
| collection | DOAJ |
| description | Abstract Aims This study aimed to evaluate the impact of coronavirus disease 2019 (Covid‐19) outbreak on admissions for acute myocardial infarction (AMI) and related mortality, severity of presentation, major cardiac complications and outcome in a tertiary‐care university hospital in Berlin, Germany. Methods and results In a single‐centre cross‐sectional observational study, we included 355 patients with AMI containing ST‐elevation or non‐ST‐elevation myocardial infarction (STEMI or NSTEMI), admitted for emergency cardiac catheterization between January and April 2020 and the equivalent time in 2019. During the early phase of the Covid‐19 pandemic (e‐COV) in Berlin (March and April 2020), admissions for AMI halved compared with those in the pre‐Covid‐19 time (January and February 2020; pre‐COV) and with those in the corresponding months in 2019. However, mortality for AMI increased substantially from 5.2% pre‐COV to 17.7% (P < 0.05) during e‐COV. Severity of presentation for AMI was more pronounced during e‐COV [increased levels of cardiac enzymes, reduced left ventricular ejection fraction (LVEF), an increase in the need of inotropic support by 25% (P < 0.01)], while patients' demographic and angiographic characteristics did not differ between pre‐COV and e‐COV. Time from symptom onset to first medical contact was prolonged in all AMI during e‐COV (presentation > 72 h +21% in STEMI, p = 0.04 and presentation > 72 h in NSTEMI +22%, p = 0.02). Door to balloon time was similar in STEMI patients, while time from first medical contact to revascularization was significantly delayed in NSTEMI patients (p = 0.02). Major cardiac complications after AMI occurred significantly more often, and cardiac recovery was worse in e‐COV than in pre‐COV, demonstrated by a significantly lower LVEF (39 ± 16 vs. 46 ± 16, p < 0.05) at hospital discharge and substantially higher NTproBNP levels. Conclusions The Covid‐19 outbreak affects hospital admissions for acute coronary syndromes. During the first phase of the pandemia, significantly less patients with AMI were admitted, but those admitted presented with a more severe phenotype and had a higher mortality, more complications, and a worse short‐term outcome. Therefore, our data indicate that Covid‐19 had relevant impact on non‐infectious disease states, such as acute coronary syndromes. |
| first_indexed | 2024-12-20T04:56:07Z |
| format | Article |
| id | doaj.art-2b813ba4c17344d59d3df00c09450d55 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-12-20T04:56:07Z |
| publishDate | 2021-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-2b813ba4c17344d59d3df00c09450d552022-12-21T19:52:43ZengWileyESC Heart Failure2055-58222021-02-018133334310.1002/ehf2.13075Increased mortality and worse cardiac outcome of acute myocardial infarction during the early COVID‐19 pandemicUwe Primessnig0Burkert M. Pieske1Mohammad Sherif2Department of Internal Medicine and Cardiology Charité—Universitätsmedizin Berlin Campus Virchow‐Klinikum, Augustenburger Platz 1 Berlin 13353 GermanyDepartment of Internal Medicine and Cardiology Charité—Universitätsmedizin Berlin Campus Virchow‐Klinikum, Augustenburger Platz 1 Berlin 13353 GermanyDepartment of Internal Medicine and Cardiology Charité—Universitätsmedizin Berlin Campus Virchow‐Klinikum, Augustenburger Platz 1 Berlin 13353 GermanyAbstract Aims This study aimed to evaluate the impact of coronavirus disease 2019 (Covid‐19) outbreak on admissions for acute myocardial infarction (AMI) and related mortality, severity of presentation, major cardiac complications and outcome in a tertiary‐care university hospital in Berlin, Germany. Methods and results In a single‐centre cross‐sectional observational study, we included 355 patients with AMI containing ST‐elevation or non‐ST‐elevation myocardial infarction (STEMI or NSTEMI), admitted for emergency cardiac catheterization between January and April 2020 and the equivalent time in 2019. During the early phase of the Covid‐19 pandemic (e‐COV) in Berlin (March and April 2020), admissions for AMI halved compared with those in the pre‐Covid‐19 time (January and February 2020; pre‐COV) and with those in the corresponding months in 2019. However, mortality for AMI increased substantially from 5.2% pre‐COV to 17.7% (P < 0.05) during e‐COV. Severity of presentation for AMI was more pronounced during e‐COV [increased levels of cardiac enzymes, reduced left ventricular ejection fraction (LVEF), an increase in the need of inotropic support by 25% (P < 0.01)], while patients' demographic and angiographic characteristics did not differ between pre‐COV and e‐COV. Time from symptom onset to first medical contact was prolonged in all AMI during e‐COV (presentation > 72 h +21% in STEMI, p = 0.04 and presentation > 72 h in NSTEMI +22%, p = 0.02). Door to balloon time was similar in STEMI patients, while time from first medical contact to revascularization was significantly delayed in NSTEMI patients (p = 0.02). Major cardiac complications after AMI occurred significantly more often, and cardiac recovery was worse in e‐COV than in pre‐COV, demonstrated by a significantly lower LVEF (39 ± 16 vs. 46 ± 16, p < 0.05) at hospital discharge and substantially higher NTproBNP levels. Conclusions The Covid‐19 outbreak affects hospital admissions for acute coronary syndromes. During the first phase of the pandemia, significantly less patients with AMI were admitted, but those admitted presented with a more severe phenotype and had a higher mortality, more complications, and a worse short‐term outcome. Therefore, our data indicate that Covid‐19 had relevant impact on non‐infectious disease states, such as acute coronary syndromes.https://doi.org/10.1002/ehf2.13075Acute myocardial infarctionCovid‐19SARS‐CoV‐2STEMINSTEMIPercutaneous coronary intervention |
| spellingShingle | Uwe Primessnig Burkert M. Pieske Mohammad Sherif Increased mortality and worse cardiac outcome of acute myocardial infarction during the early COVID‐19 pandemic ESC Heart Failure Acute myocardial infarction Covid‐19 SARS‐CoV‐2 STEMI NSTEMI Percutaneous coronary intervention |
| title | Increased mortality and worse cardiac outcome of acute myocardial infarction during the early COVID‐19 pandemic |
| title_full | Increased mortality and worse cardiac outcome of acute myocardial infarction during the early COVID‐19 pandemic |
| title_fullStr | Increased mortality and worse cardiac outcome of acute myocardial infarction during the early COVID‐19 pandemic |
| title_full_unstemmed | Increased mortality and worse cardiac outcome of acute myocardial infarction during the early COVID‐19 pandemic |
| title_short | Increased mortality and worse cardiac outcome of acute myocardial infarction during the early COVID‐19 pandemic |
| title_sort | increased mortality and worse cardiac outcome of acute myocardial infarction during the early covid 19 pandemic |
| topic | Acute myocardial infarction Covid‐19 SARS‐CoV‐2 STEMI NSTEMI Percutaneous coronary intervention |
| url | https://doi.org/10.1002/ehf2.13075 |
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