NACMI: In-Hospital Mortality Rate in STEMI Patients With COVID-19 Dropped in 2021
Deaths among hospitalized patients who had both COVID-19 and a STEMI were 25% lower in 2021 than in 2020, and no deaths occurred among STEMI patients who had been vaccinated against COVID-19, according to a study presented April 4 during ACC.22 and simultaneously published in the Journal of the American College of Cardiology.
Santiago Garcia, MD, FACC, et al., used the North American COVID-19 STEMI (NACMI) registry to compare outcomes of 586 hospitalized patients who had both COVID-19 and a STEMI. Among those, 227 patients were treated in 2020 before COVID-19 vaccines became available, and 359 patients were treated in 2021 after COVID-19 vaccines had received emergency use authorization from the U.S. Food and Drug Administration. The study's primary endpoint was in-hospital mortality, and the secondary endpoint was a composite of death, stroke or a repeat myocardial infarction (MI).
In 2021, 83 patients out of 359 (23%) died in the hospital, compared with 75 out of 227 (33%) in 2020. Of the 359 patients treated in 2021, 90 (25%) died or had a stroke or repeat MI, compared with 80 of the 227 patients (35%) treated in 2020. The risk of in-hospital death was 70% higher for patients who had pulmonary infiltrates, low blood pressure or cardiogenic shock. Patients aged 66 or older and those with diabetes were also more likely to die in the hospital.
Vaccination data was available for 193 (54%) of the patients treated in 2021. Of these, 22 patients (11%) had been vaccinated, and none died in the hospital. By contrast, 37 of the 171 unvaccinated patients (22%) died in the hospital – an in-hospital death rate considerably above the expected rate of about 4% - 6% for patients who have had a STEMI, according to Garcia. Researchers also found vaccinated patients were far less likely to experience severe respiratory illness, providing "additional support for the value of COVID-19 vaccination in older adults."
"In 2020, before vaccines were available for COVID-19, we saw significantly more patients presenting to the hospital with shortness of breath as their primary symptom, rather than with the more typical heart-attack symptom of chest pain," Garcia said. "Having shortness of breath, having an abnormal chest X-ray and needing to be on a ventilator were all factors that increased patients' risk of dying ... In 2021, however, the availability of vaccines significantly reduced hospitalizations and deaths due to COVID-19 infection, including among patients who had a STEMI."
Keywords: ACC Annual Scientific Session, ACC22, COVID-19, Myocardial Infarction, SARS-CoV-2, Thrombolytic Therapy
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