Alexander Fardman1,2, Doron Zahger3,4, Katia Orvin2,5, Daniel Oren1,2, Natalia Kofman2,6, Jameel Mohsen7,8, Or Tsafrir9,10, Elad Asher11,12, Ronen Rubinshtein2,13, Jafari Jamal4,14, Roi Efraim8,15, Majdi Halabi10,16, Yacov Shacham2,17, Lior Henri Fortis4,18, Tal Cohen1,2, Robert Klempfner1,2, Amit Segev1,2, Roy Beigel1,2, Shlomi Matetzky1,2. 1. Lev Leviev Heart and Vascular Center, Sheba Medical Center, Tel Hashomer, Israel. 2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Department of Cardiology, Soroka University Medical Center, Beer Sheva, Israel. 4. Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel. 5. Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel. 6. Department of Cardiology, Shamir Medical Center, Tzrifin, Israel. 7. Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel. 8. Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. 9. Division of Cardiology, Galilee Medical Center, Nahariya, Israel. 10. Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel. 11. The Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel. 12. Faculty of Medicine, Hebrew University, Jerusalem, Israel. 13. Department of Cardiology, Wolfson Medical Center, Holon, Israel. 14. Cardiology Department, Barzilai University Medical Center, Ashkelon, Israel. 15. Department of Cardiology, Rambam Healthcare Campus, Haifa, Israel. 16. Department of Cardiology, Ziv Medical Center, Safed, Israel. 17. Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. 18. Department of Cardiology, Samson Assuta Ashdod University Hospital, Ashdod, Israel.
Abstract
BACKGROUND: We aimed to describe the characteristics and in-hospital outcomes of ST-segment elevation myocardial infarction (STEMI) patients during the Covid-19 era. METHODS: We conducted a prospective, multicenter study involving 13 intensive cardiac care units, to evaluate consecutive STEMI patients admitted throughout an 8-week period during the Covid-19 outbreak. These patients were compared with consecutive STEMI patients admitted during the corresponding period in 2018 who had been prospectively documented in the Israeli bi-annual National Acute Coronary Syndrome Survey. The primary end-point was defined as a composite of malignant arrhythmia, congestive heart failure, and/or in-hospital mortality. Secondary outcomes included individual components of primary outcome, cardiogenic shock, mechanical complications, electrical complications, re-infarction, stroke, and pericarditis. RESULTS: The study cohort comprised 1466 consecutive acute MI patients, of whom 774 (53%) were hospitalized during the Covid-19 outbreak. Overall, 841 patients were diagnosed with STEMI: 424 (50.4%) during the Covid-19 era and 417 (49.6%) during the parallel period in 2018. Although STEMI patients admitted during the Covid-19 period had fewer co-morbidities, they presented with a higher Killip class (p value = .03). The median time from symptom onset to reperfusion was extended from 180 minutes (IQR 122-292) in 2018 to 290 minutes (IQR 161-1080, p < .001) in 2020. Hospitalization during the Covid-19 era was independently associated with an increased risk of the combined endpoint in the multivariable regression model (OR 1.65, 95% CI 1.03-2.68, p value = .04). Furthermore, the rate of mechanical complications was four times higher during the Covid-19 era (95% CI 1.42-14.8, p-value = .02). However, in-hospital mortality remained unchanged (OR 1.73, 95% CI 0.81-3.78, p-value = .16). CONCLUSIONS: STEMI patients admitted during the first wave of Covid-19 outbreak, experienced longer total ischemic time, which was translated into a more severe disease status upon hospital admission, and a higher rate of in-hospital adverse events, compared with parallel period.
BACKGROUND: We aimed to describe the characteristics and in-hospital outcomes of ST-segment elevation myocardial infarction (STEMI) patients during the Covid-19 era. METHODS: We conducted a prospective, multicenter study involving 13 intensive cardiac care units, to evaluate consecutive STEMI patients admitted throughout an 8-week period during the Covid-19 outbreak. These patients were compared with consecutive STEMI patients admitted during the corresponding period in 2018 who had been prospectively documented in the Israeli bi-annual National Acute Coronary Syndrome Survey. The primary end-point was defined as a composite of malignant arrhythmia, congestive heart failure, and/or in-hospital mortality. Secondary outcomes included individual components of primary outcome, cardiogenic shock, mechanical complications, electrical complications, re-infarction, stroke, and pericarditis. RESULTS: The study cohort comprised 1466 consecutive acute MI patients, of whom 774 (53%) were hospitalized during the Covid-19 outbreak. Overall, 841 patients were diagnosed with STEMI: 424 (50.4%) during the Covid-19 era and 417 (49.6%) during the parallel period in 2018. Although STEMI patients admitted during the Covid-19 period had fewer co-morbidities, they presented with a higher Killip class (p value = .03). The median time from symptom onset to reperfusion was extended from 180 minutes (IQR 122-292) in 2018 to 290 minutes (IQR 161-1080, p < .001) in 2020. Hospitalization during the Covid-19 era was independently associated with an increased risk of the combined endpoint in the multivariable regression model (OR 1.65, 95% CI 1.03-2.68, p value = .04). Furthermore, the rate of mechanical complications was four times higher during the Covid-19 era (95% CI 1.42-14.8, p-value = .02). However, in-hospital mortality remained unchanged (OR 1.73, 95% CI 0.81-3.78, p-value = .16). CONCLUSIONS: STEMI patients admitted during the first wave of Covid-19 outbreak, experienced longer total ischemic time, which was translated into a more severe disease status upon hospital admission, and a higher rate of in-hospital adverse events, compared with parallel period.
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