Case Brian C, Yerasi Charan, Forrestal Brian J, Shea Corey, Rappaport Hank, Medranda Giorgio A, Zhang Cheng, Satler Lowell F, Ben-Dor Itsik, Hashim Hayder, Rogers Toby, Waksman Ron
Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland.
Am J Cardiol. 2021 Apr 1;144:8-12. doi: 10.1016/j.amjcard.2020.12.059. Epub 2020 Dec 29.
The coronavirus disease 2019 (COVID-19) pandemic has greatly impacted the US healthcare system. Cardiac involvement in COVID-19 is common and manifested by troponin and natriuretic peptide elevation and tends to have a worse prognosis. We analyzed patients who presented to the MedStar Health system (11 hospitals in Washington, DC, and Maryland) with either an ST-elevation myocardial infarction or non-ST-elevation myocardial infarction early in the pandemic (March 1, 2020 to June 30, 2020) using the International Classification of Diseases, Tenth Revision. Patients' clinical course and outcomes, including in-hospital mortality, were compared on the basis of the results of COVID-19 status (positive or negative). The cohort included 1533 patients admitted with an acute myocardial infarction (AMI), of whom 86 had confirmed severe acute respiratory syndrome coronavirus 2 infection, during the study period. COVID-19-positive patients were older and non-White and had more co-morbidities. Furthermore, inflammatory markers and N-terminal-proB-type-natriuretic peptide were higher in COVID-19-positive AMI patients. Only 20.0% (17) of COVID-19-positive patients underwent coronary angiography. In-hospital mortality was significantly higher in AMI patients with concomitant COVID-19-positive status (27.9%) than in patients without COVID-19 during the same period (3.7%; p < 0.001). Patients with AMI and COVID-19 tended to be older, with more co-morbidities, when compared to those with an AMI and without COVID-19. In conclusion, myocardial infarction with concomitant COVID-19 was associated with increased in-hospital mortality. Efforts should be focused on the early recognition, evaluation, and treatment of these patients.
2019年冠状病毒病（COVID-19）大流行对美国医疗系统产生了巨大影响。COVID-19患者出现心脏受累很常见，表现为肌钙蛋白和利钠肽升高，且往往预后较差。我们使用国际疾病分类第十版，分析了在大流行早期（2020年3月1日至2020年6月30日）就诊于MedStar Health系统（华盛顿特区和马里兰州的11家医院）的ST段抬高型心肌梗死或非ST段抬高型心肌梗死患者。根据COVID-19状态（阳性或阴性）结果比较患者的临床病程和结局，包括住院死亡率。该队列包括1533例急性心肌梗死（AMI）住院患者，其中86例在研究期间确诊感染严重急性呼吸综合征冠状病毒2。COVID-19阳性患者年龄较大、非白人且合并症较多。此外，COVID-19阳性AMI患者的炎症标志物和N末端B型利钠肽前体更高。仅20.0%（17例）COVID-19阳性患者接受了冠状动脉造影。同期，合并COVID-19阳性的AMI患者住院死亡率（27.9%）显著高于未感染COVID-19的患者（3.7%；p<0.001）。与未感染COVID-19 的AMI患者相比，感染COVID-19的AMI患者往往年龄更大，合并症更多。总之，合并COVID-19的心肌梗死与住院死亡率增加相关。应致力于对这些患者进行早期识别、评估和治疗。
