The Outcome of COVID-19 Patients with Acute Myocardial Infarction

  1. Hassan Al Tamimi
  2. Yasser Alhamad
  3. Fadi Khazaal
  4. Mowahib ElHassan
  5. Hajar AlBinali
  6. Abdul rahman Arabi
  7. Awad Al-Qahtani
  8. Nidal Asaad
  9. Mohammed Al-Hijji
  10. Tahir Hamid
  11. Ihsan Rafie
  12. Ali Omrani
  13. Saad Al Kaabi
  14. Abdullatif Alkhal
  15. Muna Al Maslamani
  16. Mohamed Ali
  17. Murad Alkhani
  18. Mariam AlNesf
  19. Salem Abu Jalala
  20. Salaheddine Arafa
  21. Reem ElSousy
  22. Omar Al Tamimi
  23. Ezeldine Soaly
  24. Charbel Abi Khalil
  25. Jassim Al Suwaidi

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Abstract

Objectives

Coronavirus Disease 2019 (COVID-19) is a rapidly expanding global pandemic resulting in significant morbidity and mortality. COVID-19 patients may present with acute myocardial infarction (AMI). The aim of this study is to conduct detailed analysis on patients with AMI and COVID-19.

Methods

We included all patients admitted with AMI and actively known or found to be COVID-19 positive by PCR between the 4 th February 2020 and the 11 th June 2020 in the State of Qatar. Patients were divided into ST-elevation myocardial infarction (STEMI) and Non-STE (NSTEMI).

Results

There were 68 patients (67 men and 1 woman) admitted between the 4 th of February 2020 and the 11 th of June 2020 with AMI and COVID-19. The mean age was 49.1±9 years, 46 patients had STEMI and 22 had NSTEMI. 38% had diabetes mellitus, 31% had hypertension, 16% were smokers, 13% had dyslipidemia, and 14.7% had prior cardiovascular disease. Chest pain and dyspnea were the presenting symptoms in 90% and 12% of patients, respectively. Fever (15%) and cough (15%) were the most common COVID-19 symptoms, while the majority had no viral symptoms. Thirty-nine (33 STEMI and 6 NSTEMI) patients underwent coronary angiography, 38 of them had significant coronary disease. In-hospital MACE was low; 1 patient developed stroke and 2 died.

Conclusion

Contrary to previous small reports, in-hospital adverse events were low in this largest cohort of COVID-19 patients presenting with AMI. We hypothesize patient’s demographics and profile including younger age contributed to these findings. Further studies are required to confirm this observation.

Key questions

What is already known on this subject?

  • COVID-19 patients may present with acute myocardial infarction (AMI).

What might this study add?

  • Contrary to previous small reports, most COVID-19 patients presenting with AMI have significant obstructive coronary artery disease and favorable in-hospital outcome.

How might this impact on clinical practice?

  • COVID-19 patients presenting with AMI should be treated according to the standard practice.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.07.21.20156349: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitation of the study: Our study is constrained by the limitations inherent in all studies of observational design. We also acknowledge that this is an early report on a relatively small number of patients, however, to the best of our knowledge this is the largest reported cohort to date. Another limitation of the study is the lack of standard definition of COVID-19 associated myocardial infarction which has not been defined to date. Fourth, 35% of our AMI patients did not undergo coronary angiography because their treated physicians regarded them as low-risk cases and decided to have coronary angiography performed later once their COVID-19 infection resolved. Therefore, we do not have the angiographic data for this group at present. The current study highlights the importance of developing large-scale registries to accurately describe the association and outcome of COVID-19 AMI patients. Multiple registries are underway including North American COVID-19 ST-segment elevation myocardial infarction registry (NACMI). The registry is organized by the Society for Cardiovascular Angiography and Interventions (SCAI) and The Canadian Association of Interventional Cardiology (CAIC) in conjunction with the American College of Cardiology Interventional Council. (39). Finally, long-term data is not available.

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04430374RecruitingRegistry for a Cardiovascular Patient Who COVID-19 Infection…

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. ScreenIT

    SciScore for 10.1101/2020.07.21.20156349: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.Randomizationnot detected.Blindingnot detected.Power Analysisnot detected.Sex as a biological variableThe mean age of patients was 68±11 years, 8 patients (28.6%) were women and 3 (10.7%) had a prior myocardial infarction. 39).

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

    Limitation of the study Our study is constrained by the limitations inherent in all studies of observational design. We also acknowledge that this is an early report on a relatively small number of patients, however, to the best of our knowledge this is the largest reported cohort to date. Another limitation of the study is the lack of standard definition of COVID-19 associated myocardial infarction which has not been defined to date. Fourth, 35% of our AMI patients did not undergo coronary angiography because their treated physicians regarded them as low-risk cases and decided to have coronary angiography performed later once their COVID-19 infection resolved. Therefore, we do not have the angiographic data for this group at present. The current study highlights the importance of developing large-scale registries to accurately describe the association and outcome of COVID-19 AMI patients. Multiple registries are underway including North American COVID-19 ST-segment elevation myocardial infarction registry (NACMI). The registry is organized by the Society for Cardiovascular Angiography and Interventions (SCAI) and The Canadian Association of Interventional Cardiology (CAIC) in conjunction with the American College of Cardiology Interventional Council. (39). Finally, long-term data is not available. Conclusion: Contrary to previous small reports, the majority of COVID-19 patients presenting with AMI have significant obstructive coronary artery disease and overall excellent in-hospital outcome. We hypothesize patient’s profile including younger age contributed to these findings. Further studies are required to confirm this observation. Further studies are required to confirm this observation. Abbreviations: COVID-19 = coronavirus 2019; EMS = emergency medical services; ICU = intensive care unit; PCI = percutaneous coronary; intervention; STEMI = ST-elevation myocardial infarction, STEMI = ST-elevation myocardial infarction=Non-ST elevation myocardial infarction, NACMI = North American COVID-19 ST-segment elevation myocardial infarction registry, SCAI= Society for Cardiovascular Angiography and Interventions, CAIC= Canadian Association of Interventional Cardiology, ACEP =American College of Emergency Physicians. Compliance with Ethics Guidelines Conflict of Interest: None. The authors are responsible for the content and the writing of the manuscript.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore is not a substitute for expert review. SciScore checks for the presence and correctness of RRIDs (research resource identifiers) in the manuscript, and detects sentences that appear to be missing RRIDs. SciScore also checks to make sure that rigor criteria are addressed by authors. It does this by detecting sentences that discuss criteria such as blinding or power analysis. SciScore does not guarantee that the rigor criteria that it detects are appropriate for the particular study. Instead it assists authors, editors, and reviewers by drawing attention to sections of the manuscript that contain or should contain various rigor criteria and key resources. For details on the results shown here, including references cited, please follow this link.

  3. ScreenIT

    SciScore for 10.1101/2020.07.21.20156349: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.Randomizationnot detected.Blindingnot detected.Power Analysisnot detected.Sex as a biological variableThe mean age of patients was 68±11 years, 8 patients (28.6%) were women and 3 (10.7%) had a prior myocardial infarction.

    Table 2: Resources

    Data from additional tools added to each annotation on a weekly basis.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore is not a substitute for expert review. SciScore checks for the presence and correctness of RRIDs (research resource identifiers) in the manuscript, and detects sentences that appear to be missing RRIDs. SciScore also checks to make sure that rigor criteria are addressed by authors. It does this by detecting sentences that discuss criteria such as blinding or power analysis. SciScore does not guarantee that the rigor criteria that it detects are appropriate for the particular study. Instead it assists authors, editors, and reviewers by drawing attention to sections of the manuscript that contain or should contain various rigor criteria and key resources. For details on the results shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2020.07.21.20156349v1 on medRxiv