Clinical implications and indicators of mortality among patients hospitalized with concurrent COVID-19 and myocardial infarction

Abstract

Objective: Acute ischemic cardiac events can complicate coronavirus disease 2019 (COVID-19). This study aimed to report in-hospital characteristics of patients with acute myocardial infarction and concomitant COVID-19. Methods: This was a registry-based retrospective analysis of patients admitted with positive COVID-19 tests who suffered from acute myocardial infarction either before or during hospitalization. This study was conducted from March 01 to April 01, 2020, in a tertiary cardiovascular center, the Tehran Heart Center. We performed an exploratory analysis to compare the clinical characteristics of patients who died during hospitalization or were discharged alive. Results: In March 2020, 57 patients who had acute myocardial infarction and a confirmed diagnosis of COVID-19 were included in the study. During hospitalization, 13 patients (22.8%) died after a mean hospital stay of 8.4 days. The deceased were older than the survivors. No significant association between mortality and sex or length of hospital stay was observed. Individuals with hypertension were more likely to have a fatal outcome. Previously receiving angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers did not show any association with mortality. Regarding the laboratory data during hospitalization, higher cardiac troponin T, neutrophil count, C-reactive protein, urea, and blood urea nitrogen/creatinine ratio were observed in the mortality group. The deceased had a lower lymphocyte count than the survivors. Conclusion: Markers of worsening renal function and immune system disturbance seem to be associated with mortality in concurrent acute myocardial infarction and COVID-19. Optimizing the management of acute coronary syndrome complicating COVID-19 requires addressing such potential contributors to mortality.