Background:
Acute non-ST segment elevation myocardial infarction (NSTEMI) has been seen as a complication in patients with SARSCoV-2 infection, however, it remains unclear whether this injury results from acute coronary syndrome with direct myocardial injury (ACS-MI) versus demand ischemia (DI), the pattern of MI related to varied activation of inflammatory responses and supply-demand imbalance. Further investigation using serial electrocardiography (ECG) is needed for a thorough cardiac evaluation, as isolated changes in cardiac troponin (cTn) are not always diagnostic of intrinsic myocardial ischemia and injury.
Methods:
A retrospective chart review of baseline characteristics, highest cTn and admission ECG from SARS-CoV-2 positive patients admitted across ten different medical centers within the United States between March 1 to May 31, 2020 were obtained using electronic medical records. The primary endpoint was the identification of incidence of DI in SARS-CoV-2 viral sepsis. The secondary endpoints compared mortality.
Results:
865 patients hospitalized with SARS-CoV-2 were included in this study, with 49.60% males and 50.40% females, mean age 60 ± 17 years. Out of 221 patients with diagnosed SARS-CoV-2 viral sepsis, 15.84% (35 patients) had DI, whereas 3.62% (8 patients) had ACS-MI. In the 164 SARS-CoV-2 patients with elevated cTn, 26.22% had ACS-MI, with or without sepsis. The mortality rate for elevated cTn was found to be 19.51%. DI and ACS-MI had similar mortality rates, 40% and 39.53% respectively (no statistically significant difference). The average time from admission to death in patients with DI was 10.14 days, compared to 12.65 days in patients with ACS-MI.
Conclusion:
DI was more prevalent in SARS-CoV-2 sepsis, however, contrary to the expectation, the mortality was as high as with ACS-MI. This is the first multicenter, observational study showing the incidence of DI in SARS-CoV-2 [non-delta variant] patients through comparisons with ACS-MI. Further analysis with strict echocardiography and angiographic data will be helpful in further understanding the nature and extent of myocardial ischemia/infarction and hence the prognosis of NSTEMI in patients with SARS-CoV-2.
Footnotes
Poster Contributions
For exact presentation time, refer to the online ACC.22 Program Planner at https://www.abstractsonline.com/pp8/#!/10461
Session Title: Spotlight on Special Topics Flatboard Poster Selections: COVID
Abstract Category: 61. Spotlight on Special Topics: Coronavirus Disease (COVID-19)