Cardiology Division, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy.
Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Division of Cardiology, Department of Clinical Sciences and Community Health, University of Milan, Italy.
Cardiovasc Revasc Med. 2022 Apr;37:149-152. doi: 10.1016/j.carrev.2021.07.009. Epub 2021 Jul 7.
During Coronavirus disease 2019 (COVID-19) pandemic a reduction in ST-elevation acute myocardial infarction with an increase in in-hospital mortality has been observed. In our region the pandemic temporal trend was sinusoidal with peaks and valleys. A first outbreak was in March 2020, a reduction in May 2020 and a second outbreak in November 2020.
MATHERIALS & METHODS: Our hospital was reorganized as one of the 13 Macro-Hubs identified in Lombardy and we retrospectively analysed consecutive STEMI patients hospitalized in the three different phases of COVID-19 pandemic.
We did not register any difference in the number of STEMI hospitalized in the three phases. At multivariate analysis for the entire population COVID-19 infection was the strongest independent predictor of in-hospital mortality. Focusing on COVID-19 patients they experienced a 5-time increased incidence of in-hospital mortality (COVID-19 vs COVID-19, 47.1% vs 8.6%; p < 0.0001) mainly driven by a higher incidence of respiratory complications (COVID-19 vs COVID-19, 41.2% vs 6.2%; p < 0.0001) with a similar incidence of cardiac death.
Among STEMI admitted during different phases of pandemic, this study found an increased mortality in patients affected by COVID-19; the co-presence of COVID-19 infection leads to an increase of mortality mostly related to respiratory complications. Interestingly the different incidence in the general population of COVID-19 did not influence the incidence of STEMI.
In conclusion our data suggest the crucial need for an early and precise diagnosis of COVID-19 infection in STEMI to establish a correct management of these very high-risk patients.
在 2019 年冠状病毒病（COVID-19）大流行期间，ST 段抬高型急性心肌梗死的发病率有所下降，住院死亡率有所上升。在我们所在的地区，大流行的时间趋势呈正弦波状，有高峰和低谷。第一次疫情爆发于 2020 年 3 月，2020 年 5 月有所减少，2020 年 11 月再次爆发。
我们的医院被重组为伦巴第大区 13 个大枢纽之一，我们回顾性分析了在 COVID-19 大流行的三个不同阶段连续住院的 STEMI 患者。
我们没有发现在 COVID-19 大流行的三个阶段住院的 STEMI 患者数量有任何差异。在对整个人群进行多变量分析时，COVID-19 感染是住院死亡率的最强独立预测因素。在 COVID-19 患者中，他们的住院死亡率增加了 5 倍（COVID-19 患者 vs COVID-19 患者，47.1% vs 8.6%；p < 0.0001），主要是由于呼吸系统并发症的发生率更高（COVID-19 患者 vs COVID-19 患者，41.2% vs 6.2%；p < 0.0001），而心脏性死亡的发生率相似。
在 COVID-19 大流行的不同阶段住院的 STEMI 患者中，本研究发现 COVID-19 感染患者的死亡率增加；COVID-19 感染的共存导致死亡率增加，主要与呼吸系统并发症有关。有趣的是，COVID-19 在普通人群中的不同发病率并未影响 STEMI 的发病率。
总之，我们的数据表明，在 STEMI 患者中早期准确诊断 COVID-19 感染至关重要，以便对这些高危患者进行正确的管理。
