The primary outcome of interest was all-cause in-hospital mortality. Secondary outcomes included in-hospital composite death, recurrent myocardial infarction or stroke, composite death or stroke, new acute decompensated heart failure, and cardiogenic shock. In-hospital exploratory outcomes included mechanical complications, bleeding, blood transfusion, acute kidney injury, need for mechanical ventilation, encephalopathy, septic shock, pneumonitis, acute respiratory failure, length of stay (overall and ICU), hospitalization cost, and discharge disposition. The only postdischarge outcome available was 30-day readmission.
The out-of-hospital STEMI group included 76,434 patients (551 with COVID-19 vs. 2,755 without COVID-19 after matching) from 370 centers (64.1% aged 51-74 years; 70.3% men). The in-hospital STEMI group included 4,015 patients (252 with COVID-19 vs. 756 without COVID-19 after matching) from 353 centers (58.3% aged 51-74 years; 60.7% men).
In patients with out-of-hospital STEMI, there was no significant difference in the likelihood of undergoing primary percutaneous coronary intervention by COVID-19 status; patients with in-hospital STEMI and COVID-19 were significantly less likely to undergo invasive diagnostic or therapeutic coronary procedures than those without COVID-19.
Among patients with out-of-hospital STEMI and COVID-19 versus out-of-hospital STEMI without COVID-19, the rates of in-hospital mortality were 15.2% versus 11.2% (absolute difference, 4.1% [95% CI, 1.1%-7.0%]; P = .007). Among patients with in-hospital STEMI and COVID-19 versus in-hospital STEMI without COVID-19, the rates of in-hospital mortality were 78.5% versus 46.1% (absolute difference, 32.4% [95% CI, 29.0%-35.9%]; P <.001).
The study authors concluded that among patients with out-of-hospital or in-hospital STEMI, a concomitant diagnosis of COVID-19 was significantly linked to greater rates of in-hospital mortality compared with patients without a diagnosis of COVID-19 in the past year. They also noted that further research is needed to understand the potential mechanisms underlying this association.
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