Published June 7, 2022
Outcomes for STEMI patients with COVID-19 improved during the course of the pandemic
Early in the COVID-19 pandemic, researchers determined that a patient’s risk of heart attack, medically known as myocardial infarction, doubled in the seven days following their COVID diagnosis. These heart attacks were also associated with higher risk of mortality.
An ST-elevation myocardial infarction (STEMI) is the most dangerous type of heart attack, occurring when one of the heart’s major arteries is acutely blocked. In-hospital mortality for STEMI patients with COVID-19 was very high during the first year of the pandemic. Many of these patients were from minority backgrounds, experienced STEMI in the hospital, had pulmonary (lung) involvement and experienced cardiogenic shock, which means the heart cannot supply enough oxygen-rich blood to the body.
During 2020 and 2021, a minimally invasive procedure to open blocked coronary arteries called percutaneous coronary intervention (PCI), the preferred treatment for patients with STEMI, was used approximately 70% of cases. But both patients’ characteristics and their outcomes changed significantly between 2020 and 2021.
Rajan Patel, MD, medical director for Chronic Total Occlusion Percutaneous Coronary Intervention (CTO PCI), at Ochsner Health, was part of a team that authored “Trends in Clinical Presentation, Management, and Outcomes of STEMI in Patients With COVID-19,” published in the Journal of the American College of Cardiology.
Using data from the North American COVID-19 STEMI (NAMCI) registry, the authors compared trends in clinical characteristics, management and outcomes of patients treated in the first year of the pandemic versus the second, ending in December 2021.
The team found that, relative to 2020, patients treated in 2021 were more likely to be Caucasian, to present with typical heart attack symptoms and less likely to have lung manifestations and cardiogenic shock. In-hospital mortality decreased from 33% in 2020 to 23% in 2021 and – notably – none of the vaccinated STEMI patients, who were also less likely to develop respiratory complications, died in the hospital, whereas in-hospital death was recorded in 22% of the unvaccinated patients.
Dr. Patel and his fellow researchers determined that significant changes occurred in the clinical characteristics, management strategies and outcomes of STEMI patients with COVID-19 infection between 2020 and 2021. Overall mortality was 25% lower for patients treated in 2021 versus 2020, though in-hospital mortality remained high for unvaccinated patients.
