Baral Nischit, Abusnina Waiel, Balmuri Shravya, Seri Amith, Kambalapalli Soumya, Parajuli Prem R, Abdelazeem Basel, Bashyal Krishna P, Ojha Niranjan, Timilsina Bidhya, Paul Timir K
Department of Medicine, McLaren Flint/Michigan State University, Flint, MI, USA.
Department of Internal Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, NE, USA.
J Community Hosp Intern Med Perspect. 2022 Sep 9;12(4):17-24. doi: 10.55729/2000-9666.1103. eCollection 2022.
Patients hospitalized for acute myocardial infarction (AMI) may have concomitant positive coronavirus disease 2019 (COVID-19). We aimed to compare the risk of in-hospital mortality in patients primarily hospitalized for AMI with or without concomitant COVID-19 positive status. Using the random-effects model, we conducted a systematic review and meta-analysis of published articles from December 1, 2019, to April 1, 2022. There were eight studies with 10,128 patients, including 612 patients with COVID and 9516 patients without COVID. A total of 261 patients (42.64%) with COVID-19 positive and 612 patients (6.43%) with negative COVID-19 status died in the hospital. Pooled data showed that patients with a primary diagnosis of AMI with COVID-19 infection had more than five times increased risk of in-hospital mortality compared to patients without COVID-19 (OR: 5.06, 95% CI: 3.61, 7.09; I = 35%, P < 0.001). However, pooled data from five studies with adjustment of baseline differences in patient demographics and characteristics, comorbidities, and in-hospital pharmacology revealed more than three times increased risk of in-hospital mortality compared to patients who had primary AMI without COVID-19 infection (aOR: 3.47, 95% CI: 2.21, 5.45; I = 0%, P < 0.001). In subgroup analysis, ST-elevation myocardial infarction (STEMI) had lower in-hospital mortality (OR 4.23, 95% CI: 3.31, 5.40; I = 0%, P < 0.001) compared to non-ST-segment elevation myocardial infarction (NSTEMI) (OR 9.97, 95% CI: 5.71, 17.41; I = 0%, P < 0.001) (p-value = 0.006). Our study shows that COVID-19 infection is associated with increased in-hospital mortality in patients with index hospitalization for AMI.
因急性心肌梗死（AMI）住院的患者可能同时感染新型冠状病毒肺炎（COVID-19）。我们旨在比较主要因AMI住院且伴有或不伴有COVID-19阳性状态的患者的院内死亡风险。我们使用随机效应模型，对2019年12月1日至2022年4月1日发表的文章进行了系统评价和荟萃分析。共有八项研究，涉及10128名患者，其中包括612名COVID-19患者和9516名非COVID-19患者。共有261名（42.64%）COVID-19阳性患者和612名（6.43%）COVID-19阴性患者在医院死亡。汇总数据显示，与未感染COVID-19的患者相比，初诊为AMI且感染COVID-19的患者院内死亡风险增加了五倍多（比值比：5.06，95%置信区间：3.61，7.09；I² = 35%，P < 0.001）。然而，五项研究的汇总数据在调整了患者人口统计学和特征、合并症以及院内药理学的基线差异后显示，与初诊为AMI但未感染COVID-19的患者相比，院内死亡风险增加了三倍多（校正比值比：3.47，95%置信区间：2.21，5.45；I² = 0%，P < 0.001）。在亚组分析中，与非ST段抬高型心肌梗死（NSTEMI）相比，ST段抬高型心肌梗死（STEMI）的院内死亡率较低（比值比4.23，95%置信区间：3.31，5.40；I² = 0%，P < 0.001）（比值比9.97，95%置信区间：5.71，17.41；I² = 0%，P < 0.001）（P值 = 0.006）。我们的研究表明，COVID-19感染与因AMI首次住院的患者院内死亡率增加有关。
