University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
Eur Heart J. 2022 Mar 14;43(11):1141-1153. doi: 10.1093/eurheartj/ehab621.
The severity of myocardial tissue damage following ST-elevation myocardial infarction (STEMI) strongly determines short- and long-term prognosis. This study explored the impact of the coronavirus disease 2019 (COVID-19) pandemic and associated public health restrictions on infarct severity.
STEMI patients treated with primary percutaneous coronary intervention (PCI) and included in the prospective Magnetic Resonance Imaging in Acute ST-Elevation Myocardial Infarction (MARINA-STEMI) cohort study from 2015- 2020 (n = 474) were categorized according to (i) timeframes with and without major public health restrictions in 2020, and (ii) timeframes of major public health restrictions during 2020 and during the corresponding timeframes between 2015-2019. Myocardial damage was evaluated by cardiac magnetic resonance imaging. During major public health restrictions in 2020 (n = 48), there was an increase in infarct size (22 [IQR 12-29] vs. 14 [IQR 6-23]%, P < 0.01), a higher frequency (77% vs. 52%, P < 0.01) and larger extent of microvascular obstruction (1.5 [IQR 0.1-11.4] vs. 0.2 [IQR 0.0-2.6]%, P < 0.01) and a higher rate of intramyocardial haemorrhage (56% vs. 34%, P = 0.02) as compared to the phases without major restrictions in 2020 (n = 101). These findings were confirmed in adjusted analysis and were consistent when comparing patients admitted in 2020 versus patients admitted in the "pre-pandemic" era (2015-2019). Patient characteristics were comparable between groups, except for a significantly longer total ischemia time (P < 0.01) and higher frequency of pre-PCI Thrombolysis in Myocardial Infarction (TIMI) flow 0 during times of major restrictions (P = 0.03).
This study provides novel mechanistic insights demonstrating a significant increase in myocardial damage in STEMI patients admitted during the COVID-19 pandemic with a temporal relation to major public health restrictions.
ST 段抬高型心肌梗死（STEMI）后心肌组织损伤的严重程度强烈决定了短期和长期预后。本研究探讨了 2019 年冠状病毒病（COVID-19）大流行及其相关公共卫生限制对梗死严重程度的影响。
本研究纳入了 2015 年至 2020 年前瞻性磁共振成像急性 ST 段抬高型心肌梗死（MARINA-STEMI）队列研究中接受直接经皮冠状动脉介入治疗（PCI）的 STEMI 患者（n=474），并根据（i）2020 年有无重大公共卫生限制的时间段，和（ii）2020 年和 2015-2019 年同期重大公共卫生限制的时间段进行分类。通过心脏磁共振成像评估心肌损伤。在 2020 年重大公共卫生限制期间（n=48），梗死面积增大（22%[IQR 12-29] vs. 14%[IQR 6-23]%，P<0.01），微血管阻塞的发生率（77% vs. 52%，P<0.01）和程度（1.5[IQR 0.1-11.4] vs. 0.2[IQR 0.0-2.6]%，P<0.01）以及心肌内出血的发生率（56% vs. 34%，P=0.02）均高于 2020 年无重大限制的阶段（n=101）。这些发现在调整分析中得到了证实，并且在比较 2020 年入院的患者与“大流行前”时期（2015-2019 年）入院的患者时也是一致的。两组患者的特征除总缺血时间明显延长（P<0.01）和重大限制期间前 PCI 血栓溶解治疗心肌梗死（TIMI）血流 0 的发生率较高（P=0.03）外，无显著差异。
本研究提供了新的机制见解，表明 COVID-19 大流行期间 STEMI 患者的心肌损伤显著增加，与重大公共卫生限制具有时间相关性。
