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Acute Myocardial Infarction in the Time of COVID-19: Challenge in Challenge

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (20 March 2023) | Viewed by 28162

Special Issue Editors

Prof. Dr. Sergio Berti

E-Mail Website
Guest Editor
Diagnostic and Interventional Department of Cardiology, Ospedale del Cuore, G.Monasterio Tuscany Foundation (FTGM), 56124 Massa-Pisa, Italy
Interests: interventional cardiology; structural cardiology; acute coronary syndromes; aortic diseases; cardiovascular imaging
Special Issues, Collections and Topics in MDPI journals
Dr. Annamaria Mazzone

E-Mail Website
Guest Editor
Diagnostic and Interventional Department of Cardiology, Ospedale del Cuore, G.Monasterio Tuscany Foundation (FTGM), 56124 Massa-Pisa, Italy
Interests: clinical cardiology; echo cardiography; stress test imaging; Coronary Artery Disease; atherosclerosis; aortic valve disease in elderly; integrated biomarkers; heart team
Dr. Cristina Vassalle

E-Mail Website
Guest Editor
Fondazione CNR-Regione Toscana G. Monasterio, Via Moruzzi 1, I-56124 Pisa, Italy
Interests: medicine; biochemistry; genetics and molecular biology cardiovascular disease
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The coronavirus pandemic (COVID-19) has quickly become a worldwide health crisis, testing healthcare systems and having an unexpected adverse impact on acute care settings, including ST Elevation Myocardial Infarction (STEMI).

In particular, a worldwide fall in AMI hospitalizations has been observed during the COVID-19 pandemic. There may be many reasons for this trend.

We invite authors to submit experimental, clinical, and epidemiological studies, as well as reviews, to this Special Issue, Topics should focus on but not be limited to the following aspects that are relevant to the relationship between STEMI and COVID-19,

- prevalence data;

- epidemiological data and common risk factors;

-common biological pathways, such as inflammatory responses, procoagulant profile, endothelial dysfunction, myocardial injury, plaque instability;

-epidemiological features in relation to the disease severity and mortality increased by cardiovascular co-morbidities in the elderly;

- clinical findings related to the reduction in patient admissions following containment initiatives—the modified scenario of coronary reperfusion treatments and reorganized aspects in health care;

- available prognostic data.

Prof. Dr. Sergio Berti
Dr. Annamaria Mazzone
Dr. Cristina Vassalle
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Acute Coronary Syndromes
  • STEMI
  • COVID-19 pandemic
  • diagnosis
  • common risk factors
  • epidemiology
  • psychological features
  • pathophysiological features
  • intensive health care management
  • long-term prognosis
  • future perspectives

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Published Papers (12 papers)

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Editorial

Jump to: Research, Review

3 pages, 176 KiB  
Editorial
Acute Myocardial Infarction in the Era of COVID-19: A Challenge in a Challenge
by Annamaria Mazzone, Sergio Berti and Cristina Vassalle
J. Clin. Med. 2023, 12(18), 5779; https://doi.org/10.3390/jcm12185779 - 5 Sep 2023
Viewed by 920
Abstract
From the very beginning, the coronavirus pandemic (COVID-19) has tested the healthcare systems, having unpredictable and extreme adverse impacts on acute care clinical settings [...] Full article
(This article belongs to the Special Issue Acute Myocardial Infarction in the Time of COVID-19: Challenge in Challenge)

Research

Jump to: Editorial, Review

9 pages, 407 KiB  
Article
The Profile and All-Cause In-Hospital Mortality Dynamics of St-Segment Elevation Myocardial Infarction Patients during the Two Years of the COVID-19 Pandemic
by Nicoleta-Monica Popa-Fotea, Iulia-Adelina Grigore, Lucian Calmac, Cosmin Mihai, Vlad Bataila, Vlad Ploscaru, Bogdan Dragoescu, Horatiu Moldovan, Stefan-Sebastian Busnatu, Eugenia Panaitescu, Luminita Iliuță and Alexandru Scafa-Udriște
J. Clin. Med. 2023, 12(4), 1467; https://doi.org/10.3390/jcm12041467 - 12 Feb 2023
Cited by 3 | Viewed by 1335
Abstract
During the coronavirus pandemic 2019 (COVID-19), some studies showed differences in the profile of subjects presenting with acute coronary syndromes as well as in overall mortality due to the delay of presentation and other complications. The purpose of this study was to compare [...] Read more.
During the coronavirus pandemic 2019 (COVID-19), some studies showed differences in the profile of subjects presenting with acute coronary syndromes as well as in overall mortality due to the delay of presentation and other complications. The purpose of this study was to compare the profile and outcomes, with emphasis on all-cause in-hospital mortality, of ST-elevation myocardial infarction (STEMI) subjects presenting to the emergency department during the pandemic period compared with a control group from the previous year, 2019. The study enrolled 2011 STEMI cases, which were divided into two groups—pre-pandemic (2019–2020) and pandemic period (2020–2022). Hospital admissions for a STEMI diagnosis sharply decreased during the COVID-19 period by 30.26% during the first year and 25.4% in the second year. This trend was paralleled by a significant increase in all-cause in-hospital mortality: 11.5% in the pandemic period versus 8.1% in the previous year. There was a significant association between SARS-CoV-2 positivity and all-cause in-hospital mortality, but no correlation was found between COVID-19 diagnosis and the type of revascularization. However, the profile of subjects presenting with STEMI did not change over time during the pandemic; their demographic and comorbid characteristics remained similar. Full article
(This article belongs to the Special Issue Acute Myocardial Infarction in the Time of COVID-19: Challenge in Challenge)
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10 pages, 275 KiB  
Article
Absence of High Lipoprotein(a) Levels Is an Independent Predictor of Acute Myocardial Infarction without Coronary Lesions
by Andrea Kallmeyer, Ana María Pello Lázaro, Luis M. Blanco-Colio, Álvaro Aceña, Óscar González-Lorenzo, Nieves Tarín, Carmen Cristóbal, Carlos Gutiérrez-Landaluce, Ana Huelmos, Jairo Lumpuy-Castillo, Marta López-Castillo, Juan Manuel Montalvo, Joaquín J. Alonso Martin, Lorenzo López-Bescós, Jesús Egido, Óscar Lorenzo and José Tuñón
J. Clin. Med. 2023, 12(3), 960; https://doi.org/10.3390/jcm12030960 - 26 Jan 2023
Cited by 6 | Viewed by 1873
Abstract
The pathophysiological mechanisms underlying Myocardial Infarction with Non-Obstructive Coronary Artery Disease (MINOCA) are still under debate. Lipoprotein (a) [Lp(a)] has proinflammatory and prothrombotic actions and has been involved in the pathogenesis of atherosclerosis. However, no previous studies have linked Lp(a) levels with the [...] Read more.
The pathophysiological mechanisms underlying Myocardial Infarction with Non-Obstructive Coronary Artery Disease (MINOCA) are still under debate. Lipoprotein (a) [Lp(a)] has proinflammatory and prothrombotic actions and has been involved in the pathogenesis of atherosclerosis. However, no previous studies have linked Lp(a) levels with the probability of developing MINOCA. Moreover, the relationship between MINOCA and the plasma levels of other proatherogenic and proinflammatory molecules such as Interleukin-18 (IL18) and proprotein convertase subtilisin/kexin type 9 (PCSK9) has not been studied. We conducted a prospective, multicenter study involving 1042 patients with acute myocardial infarction (AMI). Seventy-six patients had no significant coronary lesions. All patients underwent plasma analysis on admission. MINOCA patients were younger (57 (47–68) vs. 61 (52–72) years; p = 0.010), more frequently female (44.7% vs. 21.0%; p < 0.001), and had lower rates of diabetes and of Lp(a) > 60 mg/dL (9.2% vs. 19.8%; p = 0.037) than those with coronary lesions; moreover, High Density Lipoprotein cholesterol (HDL-c) levels were higher in MINOCA patients. The absence of Lp(a) > 60 mg/dL and of diabetes were independent predictors of MINOCA, as well as female sex, high HDL-c levels, and younger age. IL-18 and PCSK9 levels were not predictors of MINOCA. During a follow-up of 5.23 (2.89, 7.37) years, the independent predictors of the primary outcome (acute ischemic events or death) in the whole sample were Lp(a) > 60 mg/dL, older age, low estimated Glomerular Filtration rate (eGFR), hypertension, previous heart failure (HF), coronary artery bypass graft, use of insulin, and no therapy with acetylsalicylic acid. In conclusion, in AMI patients, the absence of high Lp(a) levels, as well high HDL-c levels, were independent predictors of the inexistence of coronary artery disease. High Lp (a) levels were also an independent predictor of ischemic events or death. Full article
(This article belongs to the Special Issue Acute Myocardial Infarction in the Time of COVID-19: Challenge in Challenge)
9 pages, 259 KiB  
Article
Cardiac Autonomic Function in Long COVID-19 Using Heart Rate Variability: An Observational Cross-Sectional Study
by Antonio da Silva Menezes Junior, Aline Andressa Schröder, Silvia Marçal Botelho and Aline Lazara Resende
J. Clin. Med. 2023, 12(1), 100; https://doi.org/10.3390/jcm12010100 - 22 Dec 2022
Cited by 13 | Viewed by 3426
Abstract
Background: Heart rate variability is a non-invasive, measurable, and established autonomic nervous system test. Long-term COVID-19 sequelae are unclear; however, acute symptoms have been studied. Objectives: To determine autonomic cardiac differences between long COVID-19 patients and healthy controls and evaluate associations among symptoms, [...] Read more.
Background: Heart rate variability is a non-invasive, measurable, and established autonomic nervous system test. Long-term COVID-19 sequelae are unclear; however, acute symptoms have been studied. Objectives: To determine autonomic cardiac differences between long COVID-19 patients and healthy controls and evaluate associations among symptoms, comorbidities, and laboratory findings. Methods: This single-center study included long COVID-19 patients and healthy controls. The heart rate variability (HRV), a quantitative marker of autonomic activity, was monitored for 24 h using an ambulatory electrocardiogram system. HRV indices were compared between case and control groups. Symptom frequency and inflammatory markers were evaluated. A significant statistical level of 5% (p-value 0.05) was adopted. Results: A total of 47 long COVID-19 patients were compared to 42 healthy controls. Patients averaged 43.8 (SD14.8) years old, and 60.3% were female. In total, 52.5% of patients had moderate illness. Post-exercise dyspnea was most common (71.6%), and 53.2% lacked comorbidities. CNP, D-dimer, and CRP levels were elevated (p-values of 0.0098, 0.0023, and 0.0015, respectively). The control group had greater SDNN24 and SDANNI (OR = 0.98 (0.97 to 0.99; p = 0.01)). Increased low-frequency (LF) indices in COVID-19 patients (OR = 1.002 (1.0001 to 1.004; p = 0.030)) and high-frequency (HF) indices in the control group (OR = 0.987 (0.98 to 0.995; p = 0.001)) were also associated. Conclusions: Patients with long COVID-19 had lower HF values than healthy individuals. These variations are associated with increased parasympathetic activity, which may be related to long COVID-19 symptoms and inflammatory laboratory findings. Full article
(This article belongs to the Special Issue Acute Myocardial Infarction in the Time of COVID-19: Challenge in Challenge)
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10 pages, 873 KiB  
Article
Impact of COVID-19 Diagnosis on Mortality in Patients with ST-Elevation Myocardial Infarction Hospitalized during the National Outbreak in Italy
by Leonardo De Luca, Stefano Rosato, Paola D’Errigo, Barbara Giordani, Gian Francesco Mureddu, Gabriella Badoni, Fulvia Seccareccia and Giovanni Baglio
J. Clin. Med. 2022, 11(24), 7350; https://doi.org/10.3390/jcm11247350 - 10 Dec 2022
Viewed by 1450
Abstract
Background. We sought to assess the clinical impact of COVID-19 infection on mortality in patients with ST-elevation myocardial infarction (STEMI) admitted during the national outbreak in Italy. Methods. We analysed a nationwide, comprehensive, and universal administrative database of consecutive STEMI patients admitted during [...] Read more.
Background. We sought to assess the clinical impact of COVID-19 infection on mortality in patients with ST-elevation myocardial infarction (STEMI) admitted during the national outbreak in Italy. Methods. We analysed a nationwide, comprehensive, and universal administrative database of consecutive STEMI patients admitted during lockdown for COVID-19 infection (11 March–3 May 2020) and the equivalent periods of the previous 5 years in Italy. The observed rate of 30-day and 6-month all-cause mortality of STEMI patients with and without COVID-19 infection during the lockdown was compared with the expected rate of death, according to the trend of the previous 5 years. Results. During the study period, 32.910 STEMI hospitalizations occurred in Italy. Among these, 4048 STEMI patients were admitted during the 2020 outbreak: 170 (4.2%) with and 3878 (95.8%) without a COVID-19 diagnosis. According to the 5-year trend, the 2020 expected rates of 30-day and 6-month all-cause mortality were 9.2% and 12.6%, while the observed incidences of death were 10.8% (p = 0.016) and 14.4% (p = 0.017), respectively. Excluding STEMI patients with a COVID-19 diagnosis, the mortality rate resulted in accordance with the prior 5-year trend. After multiple corrections, the presence of COVID-19 diagnosis was an independent predictor of all-cause mortality at 30 days [adjusted odds ratio (OR) 4.5; 95% confidence intervals (CI) 3.09–6.45; p < 0.0001] and 6 months (adjusted OR 3.6; 95% CI: 2.47–5.12; p < 0.0001). Conclusions.During the 2020 national outbreak in Italy, COVID-19 infection significantly increased the mortality trend in patients with STEMI. Full article
(This article belongs to the Special Issue Acute Myocardial Infarction in the Time of COVID-19: Challenge in Challenge)
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13 pages, 1022 KiB  
Article
The Peripandemic Impact of the First Wave of the COVID-19 Pandemic on Management and Prognosis of ST-Segment Elevation Myocardial Infarction in China
by Hongbo Yang, Lingfeng Luo, Jiatian Cao, Yanan Song, Xueyi Weng, Feng Zhang, Xiaofeng Zhou, Yong Huo, Juying Qian, Yan Zheng, Zheyong Huang and Junbo Ge
J. Clin. Med. 2022, 11(24), 7290; https://doi.org/10.3390/jcm11247290 - 8 Dec 2022
Cited by 1 | Viewed by 2025
Abstract
Background: Rapid reperfusion of ST-segment elevation myocardial infarction (STEMI) has been challenging during the coronavirus disease 2019 (COVID-19) outbreak. Whether and to what degree there will be a residual impact when the COVID-19 pandemic has passed is unclear. Methods: This nationwide retrospective study [...] Read more.
Background: Rapid reperfusion of ST-segment elevation myocardial infarction (STEMI) has been challenging during the coronavirus disease 2019 (COVID-19) outbreak. Whether and to what degree there will be a residual impact when the COVID-19 pandemic has passed is unclear. Methods: This nationwide retrospective study was based on electronic records of STEMI patients registered in the Chinese Cardiovascular Association Database. Results: We analyzed 141,375 STEMI patients (including 4871 patients in Hubei province, where 80% of COVID-19 cases in China occurred in 2019–2020) during the pre-outbreak (23 October 2019–22 January 2020), outbreak (23 January 2020–22 April 2020), and post-outbreak (23 April 2020–22 July 2020) periods. In the post-outbreak period in Hubei province, the increased in-hospital mortality dropped to become insignificant (adjusted odds ratio compared to the pre-outbreak level (aOR) 1.40, [95% confidential interval (CI): 0.97–2.03]) and was lower than that in the outbreak period (1.62 [1.09–2.41]). The decreased odds of primary percutaneous coronary intervention (PCI) (0.73 [0.55–0.96]) and timely reperfusion (0.74 [0.62–0.88]) persisted, although they were substantially improved compared to the outbreak period (aOR of primary PCI: 0.23 [0.18–0.30] and timely reperfusion: 0.43 [0.35–0.53]). The residual impact of COVID-19 on STEMI in the post-outbreak period in non-Hubei provinces was insignificant. Conclusions: Residual pandemic impacts on STEMI management persisted after the first wave of the COVID-19 outbreak in Hubei province, the earliest and hardest hit area in China. Full article
(This article belongs to the Special Issue Acute Myocardial Infarction in the Time of COVID-19: Challenge in Challenge)
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11 pages, 1346 KiB  
Article
Comparison of the Treatment Efficacy of Rosuvastatin versus Atorvastatin Loading Prior to Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction
by Esraa M. Adel, Ahmed A. Elberry, Ahmed Abdel Aziz, Ibrahim A. Naguib, Badrah S. Alghamdi and Raghda R. S. Hussein
J. Clin. Med. 2022, 11(17), 5142; https://doi.org/10.3390/jcm11175142 - 31 Aug 2022
Cited by 2 | Viewed by 1810
Abstract
The aim of this study was to compare the effect of a single high-dose rosuvastatin versus atorvastatin preloading in ST-elevation myocardial infarction (STEMI) patients receiving primary percutaneous coronary intervention (PCI.) Methods: A total of 99 patients presented with STEMI and were randomly divided [...] Read more.
The aim of this study was to compare the effect of a single high-dose rosuvastatin versus atorvastatin preloading in ST-elevation myocardial infarction (STEMI) patients receiving primary percutaneous coronary intervention (PCI.) Methods: A total of 99 patients presented with STEMI and were randomly divided into three groups—a control group (n = 33) with no statin treatment, an atorvastatin group (n = 33) with a single 80 mg atorvastatin dose and the rosuvastatin group (n = 33) with a single 40 mg rosuvastatin dose in the emergency room (ER) prior to PCI. Post-interventional thrombolysis in myocardial infarction (TIMI) flow grade and corrected TIMI frame count (CTFC) were recorded, and ST-segment resolution was measured. Results: CTFC was significantly lower for the atorvastatin group (p-value < 0.01) than in the control group. A final TIMI flow grade 3 was achieved in 32 (97.0%) patients in the rosuvastatin group and 28 (84.8%) patients in the atorvastatin group compared with only 25 (75.8%) patients in the control group (p = 0.014). Peak CK-MB in the rosuvastatin group (263.2 [207.2–315.6]) and the atorvastatin group (208 [151.0–314.1]) was lower compared to that in the control group (398.4 [303.9–459.3]); p < 0.001. Conclusions: A single extensive dose of lipophilic atorvastatin prior to primary PCI in STEMI patients showed better improvement in microvascular myocardial perfusion compared to hydrophilic rosuvastatin. Full article
(This article belongs to the Special Issue Acute Myocardial Infarction in the Time of COVID-19: Challenge in Challenge)
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14 pages, 798 KiB  
Article
Effect of Mindfulness-Based Stress Reduction on the Well-Being, Burnout and Stress of Italian Healthcare Professionals during the COVID-19 Pandemic
by Marco Marotta, Francesca Gorini, Alessandra Parlanti, Sergio Berti and Cristina Vassalle
J. Clin. Med. 2022, 11(11), 3136; https://doi.org/10.3390/jcm11113136 - 31 May 2022
Cited by 20 | Viewed by 4366
Abstract
COVID-19 has overwhelmed healthcare systems and increased workload and distress in healthcare professionals (HCPs). The objective of this study was to evaluate baseline distress before and after the pandemic, and the effect of Mindfulness-Based Stress Reduction (MBSR) training on well-being (PGWBI), stress (PSS) [...] Read more.
COVID-19 has overwhelmed healthcare systems and increased workload and distress in healthcare professionals (HCPs). The objective of this study was to evaluate baseline distress before and after the pandemic, and the effect of Mindfulness-Based Stress Reduction (MBSR) training on well-being (PGWBI), stress (PSS) and burnout (MBI) in Italian HCPs. Moreover, the “fear of COVID-19” (FCV-19S) questionnaire was administered to HCPs participating in the post-emergency MBSR program. Baseline distress results were moderate in all groups. No differences between baseline distress were observed between the groups of HCPs beginning the MBSR courses in the pre or post pandemic period. Total PGWBI lowered with aging. Additionally, FCV-19S positively correlated with age. MBSR was able to lower distress levels, except for depersonalization, which increased, while emotional exhaustion decreased in the group enrolled in the last post-pandemic MBSR course. Levels of fear of COVID-19 in HCPs significantly decreased after MBSR training. The lack of change in baseline distress over time indicates that it is more influenced by work-related distress than by the pandemic in our HCPs. In view of its beneficial effects on psycho-emotional status, MBSR training may represent an effective strategy to reduce distress in emergency periods as well as an essential part of HCPs’ general training. Full article
(This article belongs to the Special Issue Acute Myocardial Infarction in the Time of COVID-19: Challenge in Challenge)
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11 pages, 423 KiB  
Article
Characteristics and Outcomes of Patients with Acute Coronary Syndrome and COVID-19
by Aleksandra Milovančev, Milovan Petrović, Višeslav Popadić, Tatjana Miljković, Slobodan Klašnja, Predrag Djuran, Aleksandra Ilić, Mila Kovačević, Anastazija Stojšić Milosavljević, Milica Brajković, Bogdan Crnokrak, Lidija Memon, Ana Milojević, Zoran Todorović, Milenko Čanković, Mirka Lukić Šarkanović, Snežana Bjelić, Snežana Tadić, Aleksandar Redžek and Marija Zdravković
J. Clin. Med. 2022, 11(7), 1791; https://doi.org/10.3390/jcm11071791 - 24 Mar 2022
Cited by 7 | Viewed by 2112
Abstract
Acute coronary syndrome (ACS) in patients with COVID-19 is triggered by various mechanisms and can significantly affect the patient’s further treatment and prognosis. The study aimed to investigate the characteristics, major complications, and predictors of mortality in COVID-19 patients with ACS. All consecutive [...] Read more.
Acute coronary syndrome (ACS) in patients with COVID-19 is triggered by various mechanisms and can significantly affect the patient’s further treatment and prognosis. The study aimed to investigate the characteristics, major complications, and predictors of mortality in COVID-19 patients with ACS. All consecutive patients hospitalized from 5 July 2020 to 5 May 2021 for ACS with confirmed SARS-Co-2 were prospectively enrolled and tracked for mortality until 5 June 2021. Data from the electronic records for age and diagnosis, matched non-COVID-19 and COVID-19 ACS group, were extracted and compared. Overall, 83 COVID-19 ACS patients, when compared to 166 non-COVID ACS patients, had significantly more prevalent comorbidities, unfavorable clinical characteristics on admission (acute heart failure 21.7% vs. 6.6%, p < 0.01) and higher rates of major complications, 33.7% vs. 16.8%, p < 0.01, and intrahospital 30-day mortality, 6.7% vs. 26.5%, p < 0.01. The strongest predictors of mortality were aortic regurgitation, HR 9.98, 95% CI 1.88; 52.98, p < 0.01, serum creatinine levels, HR 1.03, 95% CI 1.01; 1.04, p < 0.01, and respiratory failure therapy, HR 13.05, 95% CI 3.62; 47.01, p < 0.01. Concomitant ACS and COVID-19 is linked to underlying comorbidities, adverse presenting features, and poor outcomes. Urgent strategies are needed to improve the outcomes of these patients. Full article
(This article belongs to the Special Issue Acute Myocardial Infarction in the Time of COVID-19: Challenge in Challenge)
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16 pages, 1454 KiB  
Article
History of Heart Failure in Patients Hospitalized Due to COVID-19: Relevant Factor of In-Hospital Complications and All-Cause Mortality up to Six Months
by Mateusz Sokolski, Konrad Reszka, Tomasz Suchocki, Barbara Adamik, Adrian Doroszko, Jarosław Drobnik, Joanna Gorka-Dynysiewicz, Maria Jedrzejczyk, Krzysztof Kaliszewski, Katarzyna Kilis-Pstrusinska, Bogusława Konopska, Agnieszka Kopec, Anna Larysz, Weronika Lis, Agnieszka Matera-Witkiewicz, Lilla Pawlik-Sobecka, Marta Rosiek-Biegus, Justyna M. Sokolska, Janusz Sokolowski, Anna Zapolska-Tomasiewicz, Marcin Protasiewicz, Katarzyna Madziarska and Ewa A. Jankowskaadd Show full author list remove Hide full author list
J. Clin. Med. 2022, 11(1), 241; https://doi.org/10.3390/jcm11010241 - 3 Jan 2022
Cited by 17 | Viewed by 2880
Abstract
Background: Patients with heart failure (HF) are at high risk of unfavorable courses of COVID-19. The aim of this study was to evaluate characteristics and outcomes of COVID-19 patients with HF. Methods: Data of patients hospitalized in a tertiary hospital in Poland between [...] Read more.
Background: Patients with heart failure (HF) are at high risk of unfavorable courses of COVID-19. The aim of this study was to evaluate characteristics and outcomes of COVID-19 patients with HF. Methods: Data of patients hospitalized in a tertiary hospital in Poland between March 2020 and May 2021 with laboratory-confirmed COVID-19 were analyzed. The study population was divided into a HF group (patients with a history of HF) and a non-HF group. Results: Out of 2184 patients (65 ± 13 years old, 50% male), 12% had a history of HF. Patients from the HF group were older, more often males, had more comorbidities, more often dyspnea, pulmonary and peripheral congestion, inflammation, and end-organ damage biomarkers. HF patients had longer and more complicated hospital stay, with more frequent acute HF development as compared with non-HF. They had significantly higher mortality assessed in hospital (35% vs. 12%) at three (53% vs. 22%) and six months (72% vs. 47%). Of 76 (4%) patients who developed acute HF, 71% died during hospitalization, 79% at three, and 87% at six months. Conclusions: The history of HF identifies patients with COVID-19 who are at high risk of in-hospital complications and mortality up to six months of follow-up. Full article
(This article belongs to the Special Issue Acute Myocardial Infarction in the Time of COVID-19: Challenge in Challenge)
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13 pages, 710 KiB  
Article
Central Sleep Apnea Is Associated with an Abnormal P-Wave Terminal Force in Lead V1 in Patients with Acute Myocardial Infarction Independent from Ventricular Function
by Jan Pec, Michael Wester, Christoph Fisser, Kurt Debl, Okka W. Hamer, Florian Poschenrieder, Stefan Buchner, Lars S. Maier, Michael Arzt and Stefan Wagner
J. Clin. Med. 2021, 10(23), 5555; https://doi.org/10.3390/jcm10235555 - 26 Nov 2021
Cited by 1 | Viewed by 2200
Abstract
Sleep-disordered breathing (SDB) is highly prevalent in patients with cardiovascular disease. We have recently shown that an elevation of the electrocardiographic (ECG) parameter P wave terminal force in lead V1 (PTFV1) is linked to atrial proarrhythmic activity by stimulation of [...] Read more.
Sleep-disordered breathing (SDB) is highly prevalent in patients with cardiovascular disease. We have recently shown that an elevation of the electrocardiographic (ECG) parameter P wave terminal force in lead V1 (PTFV1) is linked to atrial proarrhythmic activity by stimulation of reactive oxygen species (ROS)-dependent pathways. Since SDB leads to increased ROS generation, we aimed to investigate the relationship between SDB-related hypoxia and PTFV1 in patients with first-time acute myocardial infarction (AMI). We examined 56 patients with first-time AMI. PTFV1 was analyzed in 12-lead ECGs and defined as abnormal when ≥4000 µV*ms. Polysomnography (PSG) to assess SDB was performed within 3–5 days after AMI. SDB was defined by an apnea-hypopnea-index (AHI) >15/h. The multivariable regression analysis showed a significant association between SDB-related hypoxia and the magnitude of PTFV1 independent from other relevant clinical co-factors. Interestingly, this association was mainly driven by central but not obstructive apnea events. Additionally, abnormal PTFV1 was associated with SDB severity (as measured by AHI, B 21.495; CI [10.872 to 32.118]; p < 0.001), suggesting that ECG may help identify patients suitable for SDB screening. Hypoxia as a consequence of central sleep apnea may result in atrial electrical remodeling measured by abnormal PTFV1 in patients with first-time AMI independent of ventricular function. The PTFV1 may be used as a clinical marker for increased SDB risk in cardiovascular patients. Full article
(This article belongs to the Special Issue Acute Myocardial Infarction in the Time of COVID-19: Challenge in Challenge)
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Review

Jump to: Editorial, Research

19 pages, 3407 KiB  
Review
Impact of SARS-CoV-2 Outbreak on Emergency Department Presentation and Prognosis of Patients with Acute Myocardial Infarction: A Systematic Review and Updated Meta-Analysis
by Emma Altobelli, Paolo Matteo Angeletti, Francesca Marzi, Fabrizio D’Ascenzo, Reimondo Petrocelli and Giuseppe Patti
J. Clin. Med. 2022, 11(9), 2323; https://doi.org/10.3390/jcm11092323 - 21 Apr 2022
Cited by 12 | Viewed by 2794
Abstract
We performed an updated meta-analysis to robustly quantify admission trends of patients with ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI) during the first wave of the pandemic and to characterize on a large basis the risk profile and early prognosis. Studies [...] Read more.
We performed an updated meta-analysis to robustly quantify admission trends of patients with ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI) during the first wave of the pandemic and to characterize on a large basis the risk profile and early prognosis. Studies having the same observation period for the comparison between SARS-CoV-2 outbreak in 2020 versus control period in 2019 were included. Primary endpoints were the relative variation of hospital admissions, the difference of in-hospital mortality for STEMI and NSTEMI. Secondary were: mortality according to countries, income levels and data quality; cardiogenic shock, mechanical complications, door-to-balloon time, time from symptom onset to first medical contact, left ventricular ejection fraction (LVEF) and troponin. In total, 61 observational studies with 125,346 patients were included. Compared with 2019, during the pandemic for STEMI were observed: a 24% reduction of hospitalizations with an impact on early survival (OR = 1.33 in-hospital mortality); the time from symptom onset to first medical contact was 91.31 min longer, whereas door-to-balloon time was increased (+5.44 min); after STEMI, the rate of cardiogenic shock was 33% higher; LVEF at discharge was decreased (−3.46); elevated high-sensitivity troponin levels (1.52) on admission. For NSTEMI, in the COVID-19 period, we observed a 31% reduction of hospitalizations and higher in-hospital deaths (OR = 1.34). The highest mortality rates among countries were: Italy OR = 3.71 (high income), Serbia OR = 2.15 (upper middle) and Pakistan OR = 1.69 (lower middle). Later hospital presentation was associated with larger infarctions, as well as with increased cardiogenic shock and in-hospital mortality. Full article
(This article belongs to the Special Issue Acute Myocardial Infarction in the Time of COVID-19: Challenge in Challenge)
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