FEATURES OF THE COURSE OF MYOCARDIAL INFARCTION IN PATIENTS WITH NOVEL CORONAVIRUS INFECTION

Highlights

According to a single-center comparative registry study, patients with myocardial infarction and new coronavirus infection can be characterized by a higher frequency and severity of hyperglycemia, as well as acute heart failure (alveolar pulmonary edema) upon admission to the hospital against with severe comorbidity (due to type 2 diabetes mellitus and a previous stroke). Type 2 diabetes mellitus can be considered a disease that makes a significant contribution to a more unfavorable course of myocardial infarction against the background of a new coronavirus infection, as well as presumably to the structure of long-term adverse outcomes in this group of patients.

Abstract

Aim. To comparatively analyze the period of inpatient care in patients with myocardial infarction (MI) complicated by the novel coronavirus infection (COVID-19).

Methods. The retrospective single-center register study involved 591 patients with MI. Of them 399 (67.5%) were men, and 192 (32.5%) were women, the mean age was 64.5 (58.0; 72.0) years. Taking into account the verified COVID-19, two groups of patients were formed. The first group included 478 (80.9%) patients with isolated MI, the second group included 113 (19.1%) patients with MI and COVID-19. A comparative assessment of demographic, clinical and anamnestic characteristics, the results of laboratory and instrumental tests and the frequency of adverse events during hospitalization in both groups was carried out. Moreover, the data of patients with a fatal outcome were analyzed as well.

Results. Patients with MI and COVID-19 were characterized by a higher frequency of prior revascularizations (23.9 vs. 12.7, p = 0.025), including coronary artery bypass grafting (7.1 vs. 2.9%, p = 0.049), stenting (16.8 vs. 9.8%, p = 0.034), and bleeding (9.8 vs. 2.7%, p = 0.002). Patients with MI and COVID-19 presented with a higher level of hyperglycemia (7.7 (6.0; 11.4) versus 6.0 (5.2; 8.0) mmol/L, p<0.001) and a comparable prevalence of type 2 diabetes mellitus. During the period of index hospitalization, patients with COVID-19 developed pulmonary edema 1.8 times more often, despite the fact that the incidence of acute heart failure ≥ class II according to Killip was 1.7 times higher in the group with isolated MI. Among all patients with MI, fatal outcome was registered in 89 (18.6%) cases, with the comparable frequency in the groups – 14.6 and 18.6%, respectively. At the same time, patients with MI and COVID-19 who died during hospitalization were characterized by a higher frequency of type 2 diabetes mellitus (3.6 times) and a prior stroke (3.7 times). The most common cause of fatal outcomes was pulmonary edema, which developed 2.3 times more often in patients with MI and COVID-19 than in patients with isolated MI.

Conclusion. There were no significant clinical differences between patients with MI and COVID-19 and patients with isolated MI, except for higher glycemia levels. A similar pattern has been discovered for in-hospital mortality. At the same time, the frequency of type 2 diabetes mellitus, prior stroke and pulmonary edema was higher in deceased patients with COVID-19.

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