Background
Coronavirus disease-2019 (COVID-19) infection-related myocardial injury is seen in approximately 20% of hospitalized patients and ST-segment elevation (STE) myocardial infarction may be the presenting clinical manifestation. Recently published data suggest that the STE may be due acute coronary occlusion or other etiologies such as myopericarditis. We assessed the clinical characteristics, electrocardiographic patterns, incidence, management, and outcomes of COVID-19 patients with STE.
Methods
We analyzed 23,406 electrocardiograms (n = 10,018) admitted to 13 New York City area hospitals between March 1 and April 30, 2020.
Results
After manual adjudication, 51 (0.5%) had focal STE, 22 (0.2%) had diffuse STE, and 9,945 did not have STE. Baseline clinical characteristics were similar among the 3 groups, albeit there was a higher percentage of patients with low ejection fraction in the diffuse STE group. Cardiac catheterization was performed on 10 patients. Three patients did not have identifiable culprit lesions. Patients with focal STE were more likely to require inotropes and die during index hospitalization. Kaplan-Meier estimated overall survival rates were 31%, 33%, and 6% in patients without STE, focal, and diffuse STE, respectively (p < 0.0001) (Figure). By stepwise logistic regression analysis, focal STE was the strongest predictor of death (odds ratio [OR]:7.0; 95% confidence interval [CI]: 3.8 to 13.0; p < 0 .0001) followed by age > 65 years (OR: 3.5; 95% CI: 3.1 to 3.9; p < 0.0001), and diffuse STE (OR: 2.9; 95% CI: 1.1 to 7.2; p < 0.0001). Female sex was associated with a decreased risk (OR: 0.72; 95% CI: 0.65 to 0.79; p < 0.0001).
Conclusion
In this large retrospective analysis of 10,018 COVID-19 patients, we observed that STE as a manifestation of cardiovascular involvement with COVID-19 infections correlated with worse outcomes. Additionally, 1) a very small percentage (0.7%) presented with STE; 2) 70% had focal STE and 30% had diffuse STE; 3) a minority underwent coronary angiography; 4) in-hospital mortality rates were more so for those with focal STE (63% vs. 46%); and 5) focal STE was the strongest predictor of in-hospital mortality and female sex was a predictor of survival.
Categories
OTHER: COVID-19