Acute MI fatality rate higher than expected during COVID-19 pandemic
In a cross-sectional study of patients with acute MI, there were more observed fatalities than expected during the early period of the COVID-19 pandemic.
In the later period of the pandemic, there were more observed fatalities than expected for patients with STEMI but not for the overall acute MI population, researchers reported.
Cardiology Today Next Gen Innovator Ty J. Gluckman, MD, FACC, FAHA, medical director of the Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health in Portland, Oregon, and colleagues retrospectively analyzed 15,244 patients (mean age, 68 years; 66% men; 33% with STEMI) hospitalized for acute MI at one of 49 centers in six Western states between December 30, 2018 and May 16, 2020.
Patients were stratified into the pre-COVID-19 period (December 30, 2018, to February 22, 2020), the early COVID-19 period (February 23 to March 28) and the later COVID-19 period (March 29 to May 16).
In the early COVID-19 period, acute MI hospitalizations declined by 19 cases per week (95% CI, –29 to –9). In the later COVID-19 period, acute MI hospitalizations rose by 10.5 cases per week (95% CI, 4.6-16.5), but as of the week of May 10 had not returned to the rates observed in the pre-COVID-19 period, Gluckman and colleagues wrote.
“Among the many factors likely associated with this rebound in cases was encouragement of patients with symptoms or signs of acute MI to seek immediate medical attention, even amid the pandemic,” Gluckman and colleagues wrote.
There were no differences between the periods in patient demographics, CV comorbidities or treatment approaches.
The observed-to-expected mortality ratio for all acute MIs increased during the early COVID-19 period (1.27; 95% CI, 1.07-1.48), driven by patients with STEMI (1.96; 95% CI, 1.22-2.7), according to the researchers.
While the overall acute MI population did not have a significantly increased observed-to-expected mortality ratio in the later COVID-19 period (1.23; 95% CI, 0.98-1.47), the STEMI population did (2.4; 95% CI, 1.65-3.16), even after risk adjustment (OR = 1.52; 95% CI, 1.02-2.26), Gluckman and colleagues wrote.
"Given the time-sensitive nature of STEMI, any delay by patients, emergency medical services, the emergency department or cardiac catheterization laboratory may have played a role,” the researchers wrote. “Additional complications from delayed reperfusion (eg, conduction disturbances, heart failure, cardiogenic shock, and mechanical complications) may have occurred in some patients. Further research is needed to identify factors associated with the higher mortality rate in patients with STEMI."