Characteristics and outcomes of patients presenting with acute myocardial infarction and cardiogenic shock during COVID-19

Michael J Ahlers, Pratyaksh K Srivastava, Mir B Basir, William W O'Neill, Michael Hacala, Kareem Ammar, Suzan Khalil, John Hollowed, Ali Nsair, Michael J Ahlers, Pratyaksh K Srivastava, Mir B Basir, William W O'Neill, Michael Hacala, Kareem Ammar, Suzan Khalil, John Hollowed, Ali Nsair

Abstract

Objectives: To evaluate characteristics and outcomes of patients presenting with acute myocardial infarction and cardiogenic shock (AMICS) during the coronavirus disease 2019 (COVID-19) pandemic.

Background: The COVID-19 pandemic has created challenges in delivering acute cardiovascular care. Quality measures and outcomes of patients presenting with AMICS during COVID-19 in the United States have not been well described.

Methods: We identified 406 patients from the National Cardiogenic Shock Initiative (NCSI) with AMICS and divided them into those presenting before (N = 346, 5/9/2016-2/29/2020) and those presenting during the COVID-19 pandemic (N = 60, 3/1/2020-11/10/2020). We compared baseline clinical data, admission characteristics, and outcomes.

Results: The median age of the cohort was 64 years, and 23.7% of the group was female. There were no significant differences in age, sex, and medical comorbidities between the two groups. Patients presenting during the pandemic were less likely to be Black compared to those presenting prior. Median door to balloon (90 vs. 88 min, p = 0.38), door to support (88 vs. 78 min, p = 0.13), and the onset of shock to support (74 vs. 62 min, p = 0.15) times were not significantly different between the two groups. Patients presented with ST-elevation myocardial infarction more often during the COVID-19 period (95.0% vs. 80.0%, p = 0.005). In adjusted logistic regression models, COVID-19 period did not significantly associate with survival to discharge (odds ratio [OR] 1.09, 95% confidence interval [CI] 0.54-2.19, p = 0.81) or with 1-month survival (OR 0.82, 95% CI 0.42-1.61, p = 0.56).

Conclusions: Care of patients presenting with AMICS has remained robust among hospitals participating in the NCSI during the COVID-19 pandemic.

Keywords: acute myocardial infarction/STEMI; coronary artery disease, intervention; mechanical circulatory support, ECMO/IABP/tandem/Impella; shock, cardiogenic.

Conflict of interest statement

Drs. Basir and O'Neill have consultant relationships with Abbott Vascular, Abiomed, Cardiovascular Systems, Chiesi, and Zoll. The remaining authors declare no conflict of interest.

© 2022 Wiley Periodicals LLC.

Figures

Figure 1
Figure 1
Central Illustration. Acute myocardial infarction and cardiogenic shock (AMICS) during COVID‐19. Presenting during the COVID‐19 pandemic did not decrease the risk of survival to discharge or 1 month for patients presenting with AMICS among medical centers participating in the National Cardiogenic Shock Initiative from May 2016 to November 2020. Important quality metrics such as median door to balloon time, door to support time, and the onset of shock to support also did not significantly differ compared during the COVID‐19 pandemic to prior. [Color figure can be viewed at wileyonlinelibrary.com]

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