IN Myocardial infarction kills five times more COVID-19 patients than non-infected patientsas shown in a study conducted by the Heart Attack Code Working Group of the Association for Interventional Cardiology of the Spanish Society of Cardiology (SEC), which analyzed a total of 1,010 myocardial infarctions treated in Spanish hospitals between March 14-30. April this year.
Myocardial infarction patients infected with COVID-19 had 23.1% hospital mortalitycompared with 5.7% of patients with myocardial infarction without SARS-CoV-2 infection. In addition to higher admission mortality, patients with myocardial infarction and COVID-19 had increased heart failure upon arrival at the hospital, as well as with further complications (stent thrombosis and cardiogenic shock) after the treatment of a heart attack.
“Of the total number of patients treated with myocardial infarction, 10.9% had positive CRPOriol Rodriguez Leor, the first signer of the study, points out, adding that “31.9% of COVID-19 patients were admitted to hospitals with heart failure, compared with 18.4% of those who did not suffer from COVID-19. “.
The cardiologist also clarifies that “in the group of patients with coronavirus, 3.3% had stent thrombosis, and 9.9% had cardiogenic shock after treatment of a heart attack.” These complications had 0.8% and 3.8% of patients without COVID-19, respectively. These results have great influence on daily clinical practice because they suggest that “antithrombotic therapy in myocardial infarction patients is likely to be more aggressive in these COVID-19 patients to prevent complications,” the expert said.
Heart Attack Treatment
The SEC’s recommendation during the COVID-19 pandemic was to keep percutaneous coronary intervention (PCI) or primary angioplasty as the treatment of choice for patients with myocardial infarction. In accordance with this recommendation, more than 90% of patients in both groups (with and without COVID-19) included in the study underwent mechanical reperfusion…
“Delays in reperfusion were similar in both groups, but the time between the onset of symptoms and the first medical contact was shorter in COVID-19 patients,” Rodriguez says. Particularly in patients with coronavirus the first medical contact occurred after 70 minutes on average since the onset of symptoms compared to 100 minutes in patients without this infection. According to the cardiologist, “this may be due to the fact that 9% of patients with coronavirus who have had myocardial infarction have already been hospitalized, compared to 0.7% of patients without COVID-19.”
The study found that heart failure is more common in patients with COVID-19 and therefore has a worse clinical scenario. In addition, these patients received, probably because of their worse baseline, less pretreatment with platelet inhibitors before primary angioplasty. “Even though less use of antiplatelet therapy in COVID-19 patients could play a role“The pro-inflammatory and prothrombotic condition associated with this infection may also explain the alarming incidence of stent thrombosis in this patient population,” he muses.
This is why study participants believe that antithrombotic treatment should be more aggressive in the group of patients with myocardial infarction and concomitant coronavirus infection.