In-hospital clinical outcomes of COVID-19 patients with myocardial infarction

Document Type : Original Article

Authors

1 Department of Cardiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Vascular and Endovascular Surgery Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

3 Cardiology resident, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

4 Clinical Research Development Unit, Imam Reza Hospital , Mashhad University of Medical Sciences, Mashhad, Iran

5 Department of Cardiology, School of Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction: Hospital outcomes for myocardial infarction are among the clinical conditions influenced by the spread of COVID-19. Patients with COVID-19 frequently experience cardiovascular complications, with challenges encountered in acute management. We assessed clinical presentation, incidence, clinical outcomes and angiographic findings of myocardial infarction in COVID-19 patients.
Methods: This  study is a observational retrospective multicenter, medical diagram study was conducted on successive patients hospitalized with diagnosis of Covid-19 and myocardial infarction ,in two large referral hospitals with catheterization equipment and laboratories.COVID-19 infection was confirmed with reverse transcription–polymerase chain reaction assays of a nasopharyngeal sample or pattern of pulmonary parenchymal involvement in lung HRCT (approved by an expert respiratory or infection disease specialist). Data collected included patient demographics, comorbidities, electrocardiogram(ECG) and echocardiography results ,inpatient medication, treatment (fibrinolytic therapy, percutaneous coronary intervention  (PCI) ,coronary artery bypass graft (CABG), vasopressor use, invasive mechanical ventilation),laboratory test results (leucocyte count, C-reactive protein , D dimer, BUN, Cr, and ferritin)and outcome(duration of hospitalization, revascularization success, in-hospital reinfarction and mortality).
Results: The most common comorbidities were hypertension (29, 58%), diabetes mellitus (21, 42%), dyslipidemia (14, 28%) and smoking (5, 10%). Fourteen patients (44.4%) were treated with PCI and 8 (19.5%) patients with fibrinolytic therapy as the initial reperfusion strategy. Revascularization was successful in 62% of patients.  The median CRP level of patients died was 96, which was significantly more than the level (46) in discharged cases (p<0.001). Creatinine levels were also significantly higher in patients who died compared to those who were discharged (p=0.008).
Conclusion: The results of this study demonstrate upper mortality rate in patients with diabetes, kidney injury and high-level CRP, denoting the baseline clinical and laboratory data could be defined as prognostic markers in COVID-19 patients, especially while managing myocardial infarction with concurrent COVID-19 infection.

Keywords

References

  1. Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta bio medica: Atenei parmensis. 2020;91(1):157.
  2. Ibáñez B. Myocardial infarction in times of COVID-19. Revista Espanola de Cardiologia (English ed). 2020;73(12):975.
  3. Guo Y-R, Cao Q-D, Hong Z-S, Tan Y-Y, Chen S-D, Jin H-J, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak–an update on the status. Military medical research. 2020;7:1-10.
  4. Guan W-j, Ni Z-y, Hu Y, Liang W-h, Ou C-q, He J-x, et al. Clinical characteristics of coronavirus disease 2019 in China. New England journal of medicine. 2020;382(18):1708-20.
  5. Guzik TJ, Mohiddin SA, Dimarco A, Patel V, Savvatis K, Marelli-Berg FM, et al. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovascular research. 2020;116(10):1666-87.
  6. Tam C-CF, Cheung K-S, Lam S, Wong A, Yung A, Sze M, et al. Impact of coronavirus disease 2019 (COVID-19) outbreak on ST-segment–elevation myocardial infarction care in Hong Kong, China. Circulation: Cardiovascular Quality and Outcomes. 2020;13(4):e006631.
  7. Becker RC. COVID-19 update: Covid-19-associated coagulopathy. Journal of thrombosis and thrombolysis. 2020;50(1):54-67.
  8. Bayaz RJD, Askari VR, Tayyebi M, Ahmadi M, Heidari-Bakavoli A, Rahimi VB. Increasing cardiac troponin-I level as a cardiac injury index correlates with in-hospital mortality and biofactors in severe hospitalised COVID-19 patients. Journal of Infection and Chemotherapy. 2023;29(3):250-6.
  9. De Michele S, Sun Y, Yilmaz MM, Katsyv I, Salvatore M, Dzierba AL, et al. Forty postmortem examinations in COVID-19 patients: two distinct pathologic phenotypes and correlation with clinical and radiologic findings. American journal of clinical pathology. 2020;154(6):748-60.
  10. Hamadeh A, Aldujeli A, Briedis K, Tecson KM, Sanz-Sanchez J, Al-Obeidi A, et al. Characteristics and outcomes in patients presenting with COVID-19 and ST-segment elevation myocardial infarction. The American journal of cardiology. 2020;131:1-6.
  11. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet. 2020;395(10223):497-506.
  12. Kim I-C, Kim JY, Kim HA, Han S. COVID-19-related myocarditis in a 21-year-old female patient. European heart journal. 2020;41(19):1859-.
  13. Popovic B, Varlot J, Metzdorf PA, Jeulin H, Goehringer F, Camenzind E. Changes in characteristics and management among patients with ST‐elevation myocardial infarction due to COVID‐19 infection. Catheterization and cardiovascular interventions. 2021;97(3):E319-E26.
  14. Warren-Gash C, Hayward AC, Hemingway H, Denaxas S, Thomas SL, Timmis AD, et al. Influenza infection and risk of acute myocardial infarction in England and Wales: a CALIBER self-controlled case series study. The Journal of infectious diseases. 2012;206(11):1652-9.
  15. Claeys MJ, Coenen S, Colpaert C, Bilcke J, Beutels P, Wouters K, et al. Environmental triggers of acute myocardial infarction: results of a nationwide multiple-factorial population study. Acta Cardiologica. 2015;70(6):693-701.
  16. De Rosa S, Spaccarotella C, Basso C, Calabrò MP, Curcio A, Filardi PP, et al. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era. European heart journal. 2020;41(22):2083-8.
  17. Rastad H, Karim H, Ejtahed H-S, Tajbakhsh R, Noorisepehr M, Babaei M, et al. Risk and predictors of in-hospital mortality from COVID-19 in patients with diabetes and cardiovascular disease. Diabetology & metabolic syndrome. 2020;12(1):1-11.
  18. Mohamed MO, Gale CP, Kontopantelis E, Doran T, de Belder M, Asaria M, et al., editors. Sex differences in mortality rates and underlying conditions for COVID-19 deaths in England and Wales. Mayo Clinic Proceedings; 2020: Elsevier.
  19. Kwong JC, Schwartz KL, Campitelli MA, Chung H, Crowcroft NS, Karnauchow T, et al. Acute myocardial infarction after laboratory-confirmed influenza infection. New England Journal of Medicine. 2018;378(4):345-53.
  20. Nguyen JL, Yang W, Ito K, Matte TD, Shaman J, Kinney PL. Seasonal influenza infections and cardiovascular disease mortality. JAMA cardiology. 2016;1(3):274-81.
  21. Smeeth L, Thomas SL, Hall AJ, Hubbard R, Farrington P, Vallance P. Risk of myocardial infarction and stroke after acute infection or vaccination. New England Journal of Medicine. 2004;351(25):2611-8.
  22. Guo W, Li M, Dong Y, Zhou H, Zhang Z, Tian C, et al. Diabetes is a risk factor for the progression and prognosis of COVID‐19. Diabetes/metabolism research and reviews. 2020;36(7):e3319.
  23. Hulme KD, Gallo LA, Short KR. Influenza virus and glycemic variability in diabetes: a killer combination? Frontiers in microbiology. 2017;8:861.
  24. Rattka M, Dreyhaupt J, Winsauer C, Stuhler L, Baumhardt M, Thiessen K, et al. Effect of the COVID-19 pandemic on mortality of patients with STEMI: a systematic review and meta-analysis. Heart. 2021;107(6):482-7.
  25. Garcia S, Dehghani P, Grines C, Davidson L, Nayak KR, Saw J, et al. Initial findings from the North American COVID-19 myocardial infarction registry. Journal of the American College of Cardiology. 2021;77(16):1994-2003.
  26. Choudry FA, Hamshere SM, Rathod KS, Akhtar MM, Archbold RA, Guttmann OP, et al. High thrombus burden in patients with COVID-19 presenting with ST-segment elevation myocardial infarction. Journal of the American College of Cardiology. 2020;76(10):1168-76.
  27. Masi P, Hékimian G, Lejeune M, Chommeloux J, Desnos C, Pineton De Chambrun M, et al. Systemic inflammatory response syndrome is a major contributor to COVID-19–associated coagulopathy: insights from a prospective, single-center cohort study. Circulation. 2020;142(6):611-4.
  28. Gu H, Cirillo C, Nabeebaccus AA, Sun Z, Fang L, Xie Y, et al. First-phase ejection fraction, a measure of preclinical heart failure, is strongly associated with increased mortality in patients with COVID-19. Hypertension. 2021;77(6):2014-22.
  29. Morin DP, Manzo MA, Pantlin PG, Verma R, Bober RM, Krim SR, et al. Impact of preinfection left ventricular ejection fraction on outcomes in COVID-19 Infection. Current Problems in Cardiology. 2021;46(10):100845.
  30. Yoshinaga R, Doi Y, Ayukawa K, Ishikawa S. High-sensitivity C reactive protein as a predictor of inhospital mortality in patients with cardiovascular disease at an emergency department: a retrospective cohort study. BMJ open. 2017;7(10):e015112.
  31. Peng Y-D, Meng K, Guan H-Q, Leng L, Zhu R-R, Wang B-Y, et al. Clinical characteristics and outcomes of 112 cardiovascular disease patients infected by 2019-nCoV. Zhonghua xin xue guan bing za zhi. 2020;48(6):450-5.
  32. Elkind MS, Tai W, Coates K, Paik MC, Sacco RL. High-sensitivity C-reactive protein, lipoprotein-associated phospholipase A2, and outcome after ischemic stroke. Archives of internal medicine. 2006;166(19):2073-80.
  33. Idicula TT, Brogger J, Naess H, Waje-Andreassen U, Thomassen L. Admission C–reactive protein after acute ischemic stroke is associated with stroke severity and mortality: The'Bergen stroke study'. BMC neurology. 2009;9(1):1-9.
  34. Keskin O, Ulusoy R, Kalemoglu M, Us M, Yildirim I, Tarcin O, et al. White blood cell count and C-reactive protein predict short-term prognosis in acute myocardial infarction. Journal of international medical research. 2004;32(6):646-54.
  35. Yin W-H, Chen J-W, Jen H-L, Chiang M-C, Huang W-P, Feng A-N, et al. Independent prognostic value of elevated high-sensitivity C-reactive protein in chronic heart failure. American heart journal. 2004;147(5):931-8.
  36. Zhao X, Li J, Tang X, Jiang L, Chen J, Qiao S, et al. D-dimer as a thrombus biomarker for predicting 2-year mortality after percutaneous coronary intervention. Therapeutic advances in chronic disease. 2020;11:2040622320904302.
  37. Zhang S, Liu Y, Wang X, Yang L, Li H, Wang Y, et al. SARS-CoV-2 binds platelet ACE2 to enhance thrombosis in COVID-19. Journal of hematology & oncology. 2020;13(1):1-22.
  38. Gao Y, Li T, Han M, Li X, Wu D, Xu Y, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID‐19. Journal of medical virology. 2020;92(7):791-6.
  39. Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. Journal of thrombosis and haemostasis. 2020;18(5):1094-9.
  40. Ariëns RA, de Lange M, Snieder H, Boothby M, Spector TD, Grant PJ. Activation markers of coagulation and fibrinolysis in twins: heritability of the prethrombotic state. The Lancet. 2002;359(9307):667-71.
  41. Kothari H, Nguyen AT, Yang X, Hisada Y, Tsimikas S, Mackman N, et al. Association of D-dimer with plaque characteristics and plasma biomarkers of oxidation-specific epitopes in stable subjects with coronary artery disease. Journal of Cardiovascular Translational Research. 2018;11:221-9.
  42. Calza L, Colangeli V, Magistrelli E, Contadini I, Bon I, Re MC, et al. Significant decrease in plasma levels of D-dimer, interleukin-8, and interleukin-12 after a 12-month treatment with rosuvastatin in HIV-infected patients under antiretroviral therapy. AIDS Research and Human Retroviruses. 2017;33(2):126-32.
  43. Martinot M, Eyriey M, Gravier S, Bonijoly T, Kayser D, Ion C, et al. Predictors of mortality, ICU hospitalization, and extrapulmonary complications in COVID-19 patients. Infectious Diseases Now. 2021;51(6):518-25.
  44. Geri G, Darmon M, Zafrani L, Fartoukh M, Voiriot G, Le Marec J, et al. Acute kidney injury in SARS-CoV2-related pneumonia ICU patients: a retrospective multicenter study. Annals of Intensive Care. 2021;11(1):1-8.
  45. Punj S, Eng E, Shetty AA. Coronavirus disease 2019 and kidney injury. Current opinion in nephrology and hypertension. 2021;30(4):444-9.
  46. Mali SN, Thorat BR, Chopade AR. A viewpoint on angiotensin-converting enzyme 2, anti-hypertensives and Coronavirus Disease 2019 (COVID-19). Infectious Disorders-Drug Targets (Formerly Current Drug Targets-Infectious Disorders). 2021;21(3):311-3.
  47. Cappell MS. Moderately severe diarrhea and impaired renal function with COVID-19 infection. The American Journal of Gastroenterology. 2020.
  48. Alamdari NM, Afaghi S, Rahimi FS, Tarki FE, Tavana S, Zali A, et al. Mortality risk factors among hospitalized COVID-19 patients in a major referral center in Iran. The Tohoku journal of experimental medicine. 2020;252(1):73-84.
  49. Simpson E, Cantor H. Regulation of the immune response by subclasses of T lymphocytes. II. The effect of adult thymectomy upon humoral and cellular responses in mice. European Journal of Immunology. 1975;5(5):337-43.
  50. Ommen SR, Gibbons RJ, Hodge DO, Thomson SP. Usefulness of the lymphocyte concentration as a prognostic marker in coronary artery disease. American Journal of Cardiology. 1997;79(6):812-4.
  51. Zouridakis EG, Garcia-Moll X, Kaski JC. Usefulness of the blood lymphocyte count in predicting recurrent instability and death in patients with unstable angina pectoris. American Journal of Cardiology. 2000;86(4):449-51.
  52. Thomson SP, McMahon LJ, Nugent CA. Endogenous cortisol: a regulator of the number of lymphocytes in peripheral blood. Clinical immunology and immunopathology. 1980;17(4):506-14.
Journal of Cardio-Thoracic Medicine
Volume 12, Issue 1
March 2024
Pages 1295-1304

Files

Share

How to cite

Statistics