Severe Heart Attack Mortality Dropped in Second Year of COVID-19 Pandemic, But Still High in Unvaccinated, New Data Shows

A newly published analysis in the Journal of the American College of Cardiology¹ of hospitalized patients with both a severe type of heart attack called STEMI (ST-elevation myocardial infarction) and coronavirus disease-19 (COVID-19) infection compares clinical outcomes for these patients during the first and second years of the COVID-19 pandemic. The study concludes that the mortality or death rate is 25 percent lower for patients in the year 2021 compared to 2020, but that mortality remained high for patients who did not receive a COVID-19 vaccine. The authors previously reported high in-hospital mortality for STEMI patients with COVID-19 who were treated in the early phase of the pandemic.

“STEMI represent heart attacks that are caused by complete occlusion of the coronary arteries and have a very high morbidity and mortality associated with them,” said Aditya Mehra, M.D., FACC, FSCAI, a cardiologist at Hackensack Meridian Jersey Shore University Medical Center and study co-author. “STEMI heart attacks usually are more severe and potentially more dangerous compared to other types of heart attacks.”

COVID-19 infection significantly increases the risk for cardiac complications. The risk of myocardial infarction doubles within a week of receiving a COVID-19 diagnosis, which also is associated with higher odds of mortality. Patients who have a STEMI heart attack and COVID-19 constitute a high-risk subset of cardiac patients, with distinct clinical features including more patients who are minorities; the need for hospitalization; cardiac shock (the heart’s failure to pump enough blood to meet the body’s needs); and very high in-hospital mortality or death.

The newly published report is based on an analysis of trends in clinical characteristics, management strategies and outcomes of STEMI patients with COVID-19 infection using the North American COVID-19 Myocardial Infarction Registry (NACMI), which represents the largest prospective dataset worldwide of patients with these conditions. NACMI is a prospective, investigator-initiated, multi-center observational registry of hospitalized STEMI patients with confirmed or suspected COVID-19 infections in North America. NACMI was designed in early 2020.

Despite increased numbers of patients with COVID-19 worldwide, significant progress has been made in both disease prevention and management during the course of the pandemic, which has contributed to a marked reduction in mortality in some countries. Previously, reports cited a 33 percent in-hospital mortality rate for patients with STEMI and COVID-19 who were treated in North America during the early phase of the pandemic.

The authors reported that risk of in-hospital mortality for these patients in 2021 was 25 percent lower than for 2020, and patients had a marked reduction in mortality from 33 percent in 2020 to 23 percent in 2021, along with a trend for reduction in the incidence of stroke. In 2021 none of the vaccinated patients died in the hospital, whereas in-hospital death was recorded in 37 (22 percent) of unvaccinated patients.

There was no improvement in recurrence of heart attack or reinfarction, with a rate of 1.3 percent for 2020 and 2.2 percent for 2021. The composite outcome of death, stroke or reinfarction occurred in 80 of 227 patients or 35 percent in 2020 and 90 of 359 or 25 percent in 2021. The length of hospital stay decreased from 7 days in 2020 to 5 days in 2021, and intensive care unit length of stay decreased from four days in 2020 to two days in 2021.

“Significant changes have occurred in the clinical characteristics, management strategies and outcomes of STEMI patients with COVID-19 infection during the course of the pandemic, such as the availability of vaccinations, insights and changes in treatment approaches and new therapeutics for COVID-19 illness, potentially leading to the reduction in mortality rate and other metrics identified in the published analysis,” said Dr. Mehra.

A total of 586 COVID positive patients with STEMI were included in the analysis; 227 treated in 2020 and 359 treated in 2021. Patients’ characteristics changed over time. Relative to 2020, the proportion of Caucasian patients was higher (58% vs. 39%), patients presented more frequently with typical ischemic symptoms (blood flow problems) (59% vs. 51%), were less likely to have shock before a minimally invasive procedure to open blocked arteries (13% vs. 18%), or pulmonary manifestations of their cardiac illness (33% vs. 47%).

For information about Hackensack Meridian Health’s cardiovascular services, visit https://www.hackensackmeridianhealth.org/services/cardiovascular/.

Reference

¹Garcia S, Dehghani P, Stanberry L, Grines C, Patel RAG, Nayak KR, Singh A, Htun WW, Kabour A, Ghasemzadeh N, Sanina C, Aragon J, Alraies C, Benziger C, Okeson B, Garberich R, Welt FG, Davidson L, Hafiz AM, Acharya D, Stone J, Mehra A, Amlani S, Mahmud E, Giri J, Yildiz M, Henry TD, “Trends in Clinical Characteristics, Management Strategies and Outcomes of STEMI Patients with COVID-19,” Journal of the American College of Cardiology (2022), doi: https:// doi.org/10.1016/j.jacc.2022.03.345.

Study Funding

American College of Cardiology Accreditation Grant and Saskatchewan Health Research Foundation (SHRM). North American COVID-19 Myocardial Infarction Registry received financial support from Medtronic and Abbott Vascular.