Spadaccio Cristiano, Pisani Angelo, Salsano Antonio, Nenna Antonio, Fardman Alexander, D'Alessandro David, Santini Francesco, Gaudino Mario F L, Sundt Thoralf M, Rose David
Cardiac Surgery, Massachusetts General Hospital (MGH), Harvard Medical School, Boston, United States of America.
Cardiac Surgery, Pineta Grande Hospital, Castel Volturno, Naples, Italy.
Open Med (Wars). 2022 Sep 6;17(1):1412-1416. doi: 10.1515/med-2022-0545. eCollection 2022.
This study aims to compare treatments and outcomes of mechanical complications of acute myocardial infarction (MI) during the Covid-19 and in the pre-Covid-19 era. Electronic databases have been searched for MI mechanical complications during the Covid-19 era and in the previous period from January 1998 to January 2020 (pre-Covid-19 era), until October 2021. To perform a quantitative analysis of non-comparative series, a meta-analysis of proportion has been conducted. Early mortality after surgical treatment was 15.0% while it was significantly higher after conservative treatment (62.4%) ( = 0.026). Early mortality after surgical treatment was seemingly higher in the pre-Covid-19 era but the difference did not reach statistical significance (15.0% vs 38.9%; = 0.13). Mortality in patients treated conservatively, or turned down for surgery, was lower during the Covid-19 pandemic (62.4% vs 97.7%; = 0.001). The crude mean prevalence of the use rate of conservative or surgical treatment across the studies during Covid-19 and in the pre-Covid-19 era was comparable. The current increased incidence of MI mechanical complications might be a consequence of delayed presentation or restricted access to hospital facilities. Despite the general negative impact of Covid-19 on cardiac surgery volumes and outcomes and the apparent increase of the incidence of MI complications, the outcomes of their surgical and clinical treatment seem not to have been affected during the pandemic.
本研究旨在比较2019年冠状病毒病（Covid-19）期间与Covid-19大流行前急性心肌梗死（MI）机械并发症的治疗方法及结果。检索了电子数据库，以获取2019年冠状病毒病期间以及1998年1月至2020年1月（Covid-19大流行前）直至2021年10月期间的心肌梗死机械并发症情况。为了对非对照系列进行定量分析，开展了一项比例的荟萃分析。手术治疗后的早期死亡率为15.0%，而保守治疗后的早期死亡率显著更高（62.4%）（P = 0.026）。在Covid-19大流行前，手术治疗后的早期死亡率似乎更高，但差异未达到统计学意义（15.0%对38.9%；P = 0.13）。在Covid-19大流行期间，接受保守治疗或拒绝手术的患者死亡率较低（62.4%对97.7%；P = 0.001）。在Covid-19期间及Covid-19大流行前各研究中，保守或手术治疗使用率的粗平均患病率相当。目前心肌梗死机械并发症发病率的增加可能是就诊延迟或医院设施使用受限的结果。尽管Covid-19对心脏手术量和结果产生了总体负面影响，且心肌梗死并发症的发病率明显增加，但在大流行期间其手术和临床治疗结果似乎未受影响。
