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Association Between COVID-19 Diagnosis and In-Hospital Mortality in Patients Hospitalized With ST-Segment Elevation Myocardial Infarction
- Source :
- JAMA
- Publication Year :
- 2021
- Publisher :
- American Medical Association, 2021.
-
Abstract
- Importance: There has been limited research on patients with ST-segment elevation myocardial infarction (STEMI) and COVID-19. Objective: To compare characteristics, treatment, and outcomes of patients with STEMI with vs without COVID-19 infection. Design, Setting, and Participants: Retrospective cohort study of consecutive adult patients admitted between January 2019 and December 2020 (end of follow-up in January 2021) with out-of-hospital or in-hospital STEMI at 509 US centers in the Vizient Clinical Database (N = 80â¯449). Exposures: Active COVID-19 infection present during the same encounter. Main Outcomes and Measures: The primary outcome was in-hospital mortality. Patients were propensity matched on the likelihood of COVID-19 diagnosis. In the main analysis, patients with COVID-19 were compared with those without COVID-19 during the previous calendar year. Results: The out-of-hospital STEMI group included 76â¯434 patients (551 with COVID-19 vs 2755 without COVID-19 after matching) from 370 centers (64.1% aged 51-74 years; 70.3% men). The in-hospital STEMI group included 4015 patients (252 with COVID-19 vs 756 without COVID-19 after matching) from 353 centers (58.3% aged 51-74 years; 60.7% men). In patients with out-of-hospital STEMI, there was no significant difference in the likelihood of undergoing primary percutaneous coronary intervention by COVID-19 status; patients with in-hospital STEMI and COVID-19 were significantly less likely to undergo invasive diagnostic or therapeutic coronary procedures than those without COVID-19. Among patients with out-of-hospital STEMI and COVID-19 vs out-of-hospital STEMI without COVID-19, the rates of in-hospital mortality were 15.2% vs 11.2% (absolute difference, 4.1% [95% CI, 1.1%-7.0%]; P = .007). Among patients with in-hospital STEMI and COVID-19 vs in-hospital STEMI without COVID-19, the rates of in-hospital mortality were 78.5% vs 46.1% (absolute difference, 32.4% [95% CI, 29.0%-35.9%]; P < .001). Conclusions and Relevance: Among patients with out-of-hospital or in-hospital STEMI, a concomitant diagnosis of COVID-19 was significantly associated with higher rates of in-hospital mortality compared with patients without a diagnosis of COVID-19 from the past year. Further research is required to understand the potential mechanisms underlying this association.
- Subjects :
- Adult
Male
medicine.medical_specialty
Coronavirus disease 2019 (COVID-19)
Databases, Factual
medicine.medical_treatment
Myocardial Infarction
Internal medicine
medicine
ST segment
Humans
Myocardial infarction
Hospital Mortality
cardiovascular diseases
Propensity Score
Pandemics
Aged
Retrospective Studies
Original Investigation
Aged, 80 and over
business.industry
SARS-CoV-2
Case-control study
Percutaneous coronary intervention
COVID-19
Retrospective cohort study
General Medicine
Middle Aged
medicine.disease
United States
Hospitalization
Concomitant
Case-Control Studies
Propensity score matching
ST Elevation Myocardial Infarction
Female
business
Out-of-Hospital Cardiac Arrest
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- JAMA
- Accession number :
- edsair.doi.dedup.....e0a15579773229a63a2b783efc325824