Li Kang, Pan Yannan, Song Xiaojian, Yang Bin, Wang Huifeng, Yang Fan, Liu Quanbao, Lin Xinhong, Zhao Shuzhen, Yuan Yuqi, Zhang Ze, Zhang Bin, Fan Fangfang, Ma Dengfeng
Department of Cardiology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
Department of Cardiology, Taiyuan Central Hospital, No.1 East Sandao Lane, Xinghualing District, Taiyuan, 030009, Shanxi, China.
BMC Cardiovasc Disord. 2025 Mar 27;25(1):226. doi: 10.1186/s12872-025-04686-9.
The impacts of COVID-19 on acute myocardial infarction (AMI) care were heterogeneous. The study aims to analyze the clinical characteristics and outcomes of AMI patients in China during different stages of the COVID-19 pandemic.
This is a multicenter retrospective cohort study in Shanxi Province of northern China. Patients diagnosed with AMI during the zero-case, lockdown, and outbreak periods were included. Characteristics and outcomes were analyzed according to time periods and COVID-19 infection. The primary outcome was in-hospital mortality. Additional outcomes included reperfusion times, coronary angiographic measures, procedure or AMI-associated complications, arrhythmia, other adverse events, and left ventricular systolic dysfunction (LVSD).
The study included 1021 AMI patients, with 393, 250, and 378 from the zero-case, lockdown, and outbreak periods. No differences in in-hospital mortality or other adverse events were found by time periods. By infection status, 264 patients were COVID-positive, and 706 were COVID-negative. The COVID-positive ST-elevation myocardial infarction population had longer symptom-to-first medical contact (3.07 vs. 2.31, p = 0.026), pre-hospital time (4.58 vs. 3.67, p = 0.032), door-to-balloon (1.20 vs. 1.08, p = 0.046), and total ischemic time (5.80 vs. 4.70, p = 0.011). No differences in other in-hospital outcomes were found, except that multivariate logistic regression analysis demonstrated COVID-19 infection was correlated with increased risks of LVSD (OR 1.73, 95% CI 1.11-2.69, p = 0.015).
In-hospital mortality did not differ by time period or COVID-19 infection status. The COVID-positive AMI patients had longer reperfusion times and higher risks of LVSD. AMI treatments were impacted during the pandemic, and measures are warranted to minimize the reperfusion time.
新型冠状病毒肺炎（COVID-19）对急性心肌梗死（AMI）治疗的影响存在异质性。本研究旨在分析中国COVID-19大流行不同阶段AMI患者的临床特征和预后。
这是一项在中国北方山西省开展的多中心回顾性队列研究。纳入在零病例期、封控期和疫情暴发期被诊断为AMI的患者。根据时间段和COVID-19感染情况分析特征和预后。主要结局是住院死亡率。其他结局包括再灌注时间、冠状动脉造影测量、手术或AMI相关并发症、心律失常、其他不良事件以及左心室收缩功能障碍（LVSD）。
该研究纳入了1021例AMI患者，其中零病例期393例、封控期250例、疫情暴发期378例。各时间段的住院死亡率或其他不良事件未发现差异。按感染状态划分，264例患者COVID-19检测呈阳性，706例呈阴性。COVID-19检测呈阳性的ST段抬高型心肌梗死患者症状出现至首次就医时间更长（3.07天对2.31天，p = 0.026）、院前时间更长（4.58天对3.67天，p = 0.032）、门球时间更长（1.20小时对1.08小时，p = 0.046）以及总缺血时间更长（5.80小时对4.70小时，p = 0.011）。未发现其他住院结局存在差异，但多因素逻辑回归分析显示COVID-19感染与LVSD风险增加相关（比值比1.73，95%置信区间1.11 - 2.69，p = 0.015）。
住院死亡率在时间段或COVID-19感染状态方面无差异。COVID-19检测呈阳性的AMI患者再灌注时间更长且LVSD风险更高。大流行期间AMI治疗受到影响，有必要采取措施尽量缩短再灌注时间。
