Outcomes of COVID‐19‐positive acute coronary syndrome patients: A multisource electronic healthcare records study from England

  1. Muhammad Rashid
  2. Jianhua Wu
  3. Adam Timmis
  4. Nick Curzen
  5. Sarah Clarke
  6. Azfar Zaman
  7. James Nolan
  8. Ahmad Shoaib
  9. Mohamed O Mohamed
  10. Mark A. de Belder
  11. John Deanfield
  12. Chris P. Gale
  13. Mamas A. Mamas

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Background

Patients with underlying cardiovascular disease and coronavirus disease 2019 (COVID‐19) infection are at increased risk of morbidity and mortality.

Objectives

This study was designed to characterize the presenting profile and outcomes of patients hospitalized with acute coronary syndrome (ACS) and COVID‐19 infection.

Methods

This observational cohort study was conducted using multisource data from all acute NHS hospitals in England. All consecutive patients hospitalized with diagnosis of ACS with or without COVID‐19 infection between 1 March and 31 May 2020 were included. The primary outcome was in‐hospital and 30‐day mortality.

Results

A total of 12 958 patients were hospitalized with ACS during the study period, of which 517 (4.0%) were COVID‐19‐positive and were more likely to present with non‐ST‐elevation acute myocardial infarction. The COVID‐19 ACS group were generally older, Black Asian and Minority ethnicity, more comorbid and had unfavourable presenting clinical characteristics such as elevated cardiac troponin, pulmonary oedema, cardiogenic shock and poor left ventricular systolic function compared with the non‐COVID‐19 ACS group. They were less likely to receive an invasive coronary angiography (67.7% vs 81.0%), percutaneous coronary intervention (PCI) (30.2% vs 53.9%) and dual antiplatelet medication (76.3% vs 88.0%). After adjusting for all the baseline differences, patients with COVID‐19 ACS had higher in‐hospital (adjusted odds ratio (aOR): 3.27; 95% confidence interval (CI): 2.41–4.42) and 30‐day mortality (aOR: 6.53; 95% CI: 5.1–8.36) compared to patients with the non‐COVID‐19 ACS.

Conclusion

COVID‐19 infection was present in 4% of patients hospitalized with an ACS in England and is associated with lower rates of guideline‐recommended treatment and significant mortality hazard.

Article activity feed

  1. Version published to 10.1111/joim.13246
  2. ScreenIT

    SciScore for 10.1101/2020.08.20.20175091: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementConsent: Furthermore, MINAP and BCIS data are collected and hosted by the National Institute of Cardiovascular Research (NICOR) and used for audit and research purposes without formal individual patient consent under section 251 of the NHS Act 200613–16.
    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:
    However, there are some study limitations which must be kept in mind whilst interpreting these findings. First, the COVID-19 diagnosis was based on the ICD-10 codes and so it is unclear whether the diagnosis at the hospital was made on clinical grounds or using a formal polymerase chain reaction (PCR) test, and the timing of the tests leading to the diagnosis is unclear. Moreover, other suspected ACS patients were not routinely tested at the start of the pandemic and we cannot say how many might have been carrying the virus, although the lack of a COVID-19 code suggests they did not have a clinical syndrome related to the virus. Second, information around COVID-19 symptoms, their duration and other organ involvement is not captured in the datasets used in this analysis, and hence it difficult to ascertain whether patients had COVID-19 symptoms followed by an ACS or vice versa, and whether COVID-19 infection occurred in the hospital or the community. Third, whilst the MINAP registry is the UK national ACS registry for suspected type1 AMI, we cannot rule out misclassification bias from misdiagnosis of myocarditis or type 2 AMI, although only a small proportion of cases that underwent angiography had non-obstructive coronary artery disease.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    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.
    • No protocol registration statement was detected.

    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.

  3. Version published to 10.1101/2020.08.20.20175091v1 on medRxiv