Solano-López Jorge, Zamorano José Luis, Pardo Sanz Ana, Amat-Santos Ignacio, Sarnago Fernando, Gutiérrez Ibañes Enrique, Sanchis Juan, Rey Blas Juan Ramón, Gómez-Hospital Joan Antoni, Santos Martínez Sandra, Maneiro-Melón Nicolás Manuel, Mateos Gaitán Roberto, González D'Gregorio Jessika, Salido Luisa, Mestre José L, Sanmartín Marcelo, Sánchez-Recalde Ángel
Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España.
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España.
Rev Esp Cardiol. 2020 Dec;73(12):985-993. doi: 10.1016/j.recesp.2020.07.023. Epub 2020 Sep 17.
Despite advances in treatment, patients with acute myocardial infarction (AMI) still exhibit unfavorable short- and long-term prognoses. In addition, there is scant evidence about the clinical outcomes of patients with AMI and coronavirus disease 2019 (COVID-19). The objective of this study was to describe the clinical presentation, complications, and risk factors for mortality in patients admitted for AMI during the COVID-19 pandemic.
This prospective, multicenter, cohort study included all consecutive patients with AMI who underwent coronary angiography in a 30-day period corresponding chronologically with the COVID-19 outbreak (March 15 to April 15, 2020). Clinical presentations and outcomes were compared between COVID-19 and non-COVID-19 patients. The effect of COVID-19 on mortality was assessed by propensity score matching and with a multivariate logistic regression model.
In total, 187 patients were admitted for AMI, 111 with ST-segment elevation AMI and 76 with non-ST-segment elevation AMI. Of these, 32 (17%) were diagnosed with COVID-19. GRACE score, Killip-Kimball classification, and several inflammatory markers were significantly higher in COVID-19-positive patients. Total and cardiovascular mortality were also significantly higher in COVID-19-positive patients (25% vs 3.8% [ < .001] and 15.2% vs 1.8% [ = .001], respectively). GRACE score > 140 (OR, 23.45; 95%CI, 2.52-62.51; = .005) and COVID-19 (OR, 6.61; 95%CI, 1.82-24.43; = .02) were independent predictors of in-hospital death.
During this pandemic, a high GRACE score and COVID-19 were independent risk factors associated with higher in-hospital mortality.:www.revespcardiol.org/en.
尽管治疗取得了进展，但急性心肌梗死（AMI）患者的短期和长期预后仍然不佳。此外，关于AMI合并2019冠状病毒病（COVID-19）患者的临床结局的证据很少。本研究的目的是描述COVID-19大流行期间因AMI入院患者的临床表现、并发症及死亡危险因素。
这项前瞻性、多中心队列研究纳入了在与COVID-19疫情时间上对应的30天内接受冠状动脉造影的所有连续AMI患者（2020年3月15日至4月15日）。比较了COVID-19患者和非COVID-19患者的临床表现及结局。通过倾向评分匹配和多变量逻辑回归模型评估COVID-19对死亡率的影响。
共有187例患者因AMI入院，其中111例为ST段抬高型AMI，76例为非ST段抬高型AMI。其中，32例（17%）被诊断为COVID-19。COVID-19阳性患者的GRACE评分、Killip-Kimball分级及几种炎症标志物显著更高。COVID-19阳性患者的全因死亡率和心血管死亡率也显著更高（分别为25%对3.8%[<0.001]和15.2%对1.8%[P=0.001]）。GRACE评分>140（比值比，23.45；95%置信区间，2.52-62.51；P=0.005）和COVID-19（比值比，6.61；95%置信区间，1.82-24.43；P=0.02）是院内死亡的独立预测因素。
在本次大流行期间，高GRACE评分和COVID-19是与较高院内死亡率相关的独立危险因素。:www.revespcardiol.org/en.
