The 68th Annual Conference of the Israel Heart Society in association with the Israel Society of Cardiothoracic Surgery

Acute myocardial infarction in the Covid-19 era: incidence, clinical characteristics and in-hospital outcomes - A multicenter registry

Alexander Fardman 1 Doron Zahger 2 Katia Orvin 3 Daniel Oren 1 Natalia Kofman 4 Jameel Mohsen 5 Or Tsafrir 6 Elad Asher 7 Ronen Rubinshtein 8 Jafari Jamal 9 Roi Efraim 10 Majdi Halabi 11 Yacov Shacham 12 Lior Henri Fortis 13 Robert Klempfner 1 Amit Segev 1 Roy Beigel 1 Shlomi Matetzky 1
1Leviev Heart Center, Chaim Sheba Medical Center, Israel
2Department of Cardiology, Soroka University Medical Center, Israel
3Department of Cardiology, Rabin Medical Center, Israel
4Department of Cardiology, Shamir Medical Center, Israel
5Department of Cardiology, Hillel Yaffe Medical Center, Israel
6Department of Cardiology, Galilee Medical Center, Israel
7The Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Israel
8Department of Cardiology, Wolfson Medical Center, Israel
9Department of Cardiology, Barzilai University Medical Center, Israel
10Department of Cardiology, Rambam Healthcare Campus, Israel
11Department of Cardiology, Ziv Medical Center, Israel
12Department of Cardiology, Tel-Aviv Sourasky Medical Center, Israel
13Department of Cardiology, Samson Assuta Ashdod University Hospital, Israel

Background: A reduction in acute myocardial infarction (AMI) hospitalizations during the coronavirus pandemic has been previously documented. We aimed to describe the characteristics and in-hospital outcomes of AMI patients during the Covid-19 era compared to a recent previous registry.

Methods: We conducted a prospective, multicenter, observational study involving 13 intensive cardiac care units (ICCUs) to evaluate consecutive AMI patients admitted throughout an 8-week period during the Covid-19 outbreak. Data were compared to the corresponding period in 2018 using an acute coronary syndrome survey conducted in all ICCUs in Israel. The primary end-point was defined as a composite of sustained ventricular arrhythmia, pulmonary congestion, and/or in-hospital mortality.

Results: The study cohort comprised 1466 patients, of whom 774 (53%) were hospitalized during the Covid-19 outbreak. Overall, 841 patients were diagnosed with ST-elevation MI (STEMI): 424 (50.4%) during the Covid-19 era and 417 (49.6%) during the parallel period in 2018. No differences were detected in the admission rate of patients between the two study periods. STEMI patients admitted during the Covid-19 period tended to have fewer co-morbidities, but a higher Killip class (p value = .03). The median time from symptom onset to reperfusion was extended from 180 minutes (IQR 122-292) in 2018 to 290 minutes (IQR 161-1080, p<.001) in 2020. Hospitalization during the Covid-19 era was independently associated with an increased risk of the combined endpoint of heart failure, malignant arrhythmia, or death in the multivariable logistic regression model (OR 1.63, 95% CI 1.02-2.65, p value=.05).

Conclusion: While the admission rate of AMI and STEMI in Israel remained similar during both the Covid-19 era and the corresponding period in 2018, total ischemic time extended significantly during the Covid-19 period, which translated into a more severe disease status upon hospital admission, and a higher rate of in-hospital adverse events.









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