Effect of COVID-19 pandemic on six-month mortality and clinical outcomes of patients with ST-elevation myocardial infarction

Introduction
The coronavirus disease 2019 (COVID-19) infection has changed everyday clinical practice, with a shortage of solid data about its implications for ST-elevation myocardial infarction (STEMI) patients. Aim: To evaluate the impact of COVID-19 on 6-month clinical outcomes of patients with STEMI and determine the mortality predictors after STEMI during the COVID-19 pandemic.

Material and methods
This prospective observational study was conducted on consecutive STEMI patients who presented to our hospital between April and October 2021. A total of 74 COVID-19-positive patients were included in group I and compared to 148 COVID-19-negative patients (group II). We compared the two cohorts’ rates of major adverse cardiovascular events (MACEs; composite of death from any cause, recurrent MI, target-vessel revascularization, and stroke) at 6 months.

Results
COVID-19 STEMI patients were more likely to present with angina equivalent symptoms, had higher Killip class at admission, and higher levels of high-sensitive cardiac troponin T and serum C-reactive protein. The 6-month rates of MACEs were significantly higher in STEMI patients with COVID-19 compared to non-COVID-19 patients (41.9% vs. 16.9%, respectively; p < 0.001) and were mainly due to higher in-hospital mortality (20.3% vs. 6.1%, respectively; p = 0.001). The independent predictors of 6-month mortality in STEMI patients during the COVID-19 pandemic were the absence of ST resolution, low systolic blood and higher Killip class on admission, presence of severe MR and atrial fibrillation, and anterior wall STEMI.

Conclusions
STEMI patients with superimposed COVID-19 infection had worse clinical outcomes, with almost three times higher in-hospital mortality and 6-month MACEs.