Prognostic Implications of the Timing of ST-Elevation Myocardial Infarction Development in Relation to COVID-19 Infection

Aleksandra D Milošević; Marija M Polovina; Dario D Jelic; Damjan D Simic; Mihajlo M Viduljevic; Dragan M Matic; Milenko M Tomic; Tatjana N Adzic; Milika R Asanin

doi:10.1177/08850666241232938

Prognostic Implications of the Timing of ST-Elevation Myocardial Infarction Development in Relation to COVID-19 Infection

J Intensive Care Med. 2024 Feb 19:8850666241232938. doi: 10.1177/08850666241232938. Online ahead of print.

Authors

Aleksandra D Milošević^{1

2}, Marija M Polovina^{1

2}, Dario D Jelic¹, Damjan D Simic¹, Mihajlo M Viduljevic¹, Dragan M Matic^{1

2}, Milenko M Tomic¹, Tatjana N Adzic^{2

3}, Milika R Asanin^{1

2}

Affiliations

¹ Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia.
² Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
³ Department of Pulmonary Disorders and Tuberculosis, University Clinical Centre of Serbia, Belgrade, Serbia.

PMID: 38374620
DOI: 10.1177/08850666241232938

Abstract

Background: Patients with ST-segment elevation myocardial infarction (STEMI) and COVID-19 infection have a worse clinical course and prognosis. The prognostic significance of the timing of STEMI in relation to COVID-19 infection was not investigated. Objectives: To assess whether the time of STEMI development in relation to COVID-19 infection (concurrent or following the infection) influenced the short-term prognosis. Methods: This was an observational study of consecutive COVID-19 patients with STEMI admitted to the COVID-hospital Batajnica (February 2021-March 2022). The patients were divided into the "STEMI first" group: patients with STEMI and a positive polymerase chain reaction test for COVID-19, and the "COVID-19 first" group: patients who developed STEMI during COVID-19 treatment. All patients underwent coronary angiography. The primary endpoint was in-hospital all-cause mortality. Results: The study included 87 patients with STEMI and COVID-19 (M_age, 66.7 years, 66% male). The "STEMI first" group comprised 54 (62.1%) patients, and the "COVID-19 first" group included 33 (37.9%) patients. Both groups shared a comparatively high burden of comorbidities, similar angiographic and procedural characteristics, and high percentages of performed percutaneous coronary interventions with stent implantation (90.7% vs. 87.9%). In-hospital mortality was significantly higher in the "COVID-19 first" group compared to the "STEMI first" group (51.5% vs. 27.8%). Following adjustment, the "COVID-19 first" group had a hazard ratio of 3.22 (95% confidence interval, 1.18-8.75, p = .022) for in-hospital all-cause death, compared with the "STEMI first" group (reference). Conclusion: Clinical presentation with COVID-19 infection, followed by STEMI ("COVID-19 first"), was associated with greater short-term mortality compared to patients presenting with STEMI and testing positive for COVID-19 ("STEMI first").

Keywords: COVID-19; ST-segment elevation myocardial infarction; all-cause mortality; outcome; primary percutaneous coronary intervention; prognosis.