新型冠状病毒肺炎（COVID-19）合并感染对接受冠状动脉造影的急性心肌梗死患者预后的影响。
Impact of concomitant COVID-19 on the outcome of patients with acute myocardial infarction undergoing coronary artery angiography.
作者信息
Terlecki Michał, Wojciechowska Wiktoria, Klocek Marek, Olszanecka Agnieszka, Bednarski Adam, Drożdż Tomasz, Pavlinec Christopher, Lis Paweł, Zając Maciej, Rusinek Jakub, Siudak Zbigniew, Bartuś Stanisław, Rajzer Marek
机构信息
First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland.
Student's Scientific Group in the First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland.
出版信息
Front Cardiovasc Med. 2022 Sep 22;9:917250. doi: 10.3389/fcvm.2022.917250. eCollection 2022.
BACKGROUND
The impact of COVID-19 on the outcome of patients with MI has not been studied widely. We aimed to evaluate the relationship between concomitant COVID-19 and the clinical course of patients admitted due to acute myocardial infarction (MI).
METHODS
There was a comparison of retrospective data between patients with MI who were qualified for coronary angiography with concomitant COVID-19 and control group of patients treated for MI in the preceding year before the onset of the pandemic. In-hospital clinical data and the incidence of death from any cause on 30 days were obtained.
RESULTS
Data of 39 MI patients with concomitant COVID-19 (COVID-19 MI) and 196 MI patients without COVID-19 in pre-pandemic era (non-COVID-19 MI) were assessed. Compared with non-COVID-19 MI, COVID-19 MI was in a more severe clinical state on admission (lower systolic blood pressure: 128.51 ± 19.76 vs. 141.11 ± 32.47 mmHg, = 0.024), higher: respiratory rate [median (interquartile range), 16 (14-18) vs. 12 (12-14)/min, < 0.001], GRACE score (178.50 ± 46.46 vs. 161.23 ± 49.74, = 0.041), percentage of prolonged (>24 h) time since MI symptoms onset to coronary intervention (35.9 vs. 15.3%; = 0.004), and cardiovascular drugs were prescribed less frequently (beta-blockers: 64.1 vs. 92.8%, = 0.009), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers: 61.5 vs. 81.1%, < 0.001, statins: 71.8 vs. 94.4%, < 0.001). Concomitant COVID-19 was associated with seven-fold increased risk of 30-day mortality (HR 7.117; 95% CI: 2.79-18.14; < 0.001).
CONCLUSION
Patients admitted due to MI with COVID-19 have an increased 30-day mortality. Efforts should be focused on infection prevention and implementation of optimal management to improve the outcomes in those patients.
背景
新型冠状病毒肺炎（COVID-19）对心肌梗死（MI）患者预后的影响尚未得到广泛研究。我们旨在评估合并COVID-19与因急性心肌梗死（MI）入院患者临床病程之间的关系。
方法
对符合冠状动脉造影条件且合并COVID-19的MI患者与大流行开始前一年接受MI治疗的对照组患者的回顾性数据进行比较。获取住院临床数据和30天内任何原因导致的死亡发生率。
结果
评估了39例合并COVID-19的MI患者（COVID-19 MI）和196例大流行前未感染COVID-19的MI患者（非COVID-19 MI）的数据。与非COVID-19 MI相比，COVID-19 MI入院时临床状态更严重（收缩压更低：128.51±19.76 vs. 141.11±32.47 mmHg，P = 0.024），呼吸频率更高[中位数（四分位间距），16（14 - 18）vs. 12（12 - 14）/分钟，P < 0.001]，全球急性冠状动脉事件注册（GRACE）评分更高（178.50±46.46 vs. 161.23±49.74，P = 0.041），从MI症状发作到冠状动脉介入的时间延长（>24小时）的百分比更高（35.9% vs. 15.3%；P = 0.004），心血管药物的处方频率更低（β受体阻滞剂：64.1% vs. 92.8%，P = 0.009），血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂：61.5% vs. 81.1%，P < 0.001，他汀类药物：71.8% vs. 94.4%，P < 0.001）。合并COVID-19与30天死亡率增加7倍相关（风险比7.117；95%置信区间：2.79 - 18.14；P < 0.001）。
结论
因MI合并COVID-19入院的患者30天死亡率增加。应致力于预防感染并实施优化管理以改善这些患者的预后。
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