Korean Circ J.  2024 Nov;54(11):710-723. 10.4070/kcj.2024.0028.

Trends and Outcomes of Acute Myocardial Infarction During the Early COVID-19 Pandemic in the United States: A National Inpatient Sample Study

• Thyagaturu H
• Sandhyavenu H
• Titus A
• Roma N
• Gonuguntla K
• Patel NN
• Hashem A
• Abbott JD
• Balla S
• Bhatt DL

• KMID: 2560658
• DOI: http://doi.org/10.4070/kcj.2024.0028

Abstract

Background and Objectives
There are limited national data on the trends and outcomes of patients hospitalized with acute myocardial infarction (AMI) during the coronavirus disease 2019 (COVID-19) pandemic. We aimed to evaluate the impact of early COVID-19 pandemic on the trends and outcomes of AMI using the National Inpatient Sample (NIS) database.
Methods
The NIS database was queried from January 2019 to December 2020 to identify adult (age ≥18 years) AMI hospitalizations and were categorized into ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) based on International Classification of Diseases, Tenth Revision, Clinical Modification codes. In addition, the in-hospital mortality, revascularization, and resource utilization of AMI hospitalizations early in the COVID-19 pandemic (2020) were compared to those in the prepandemic period (2019) using multivariate logistic and linear regression analysis.
Results
Amongst 1,709,480 AMI hospitalizations, 209,450 STEMI and 677,355 NSTEMI occurred in 2019 while 196,230 STEMI and 626,445 NSTEMI hospitalizations occurred in 2020. Compared with those in 2019, the AMI hospitalizations in 2020 had higher odds of inhospital mortality (adjusted odds ratio [aOR], 1.27; 95% confidence interval [CI], [1.23–1.32]; p<0.01) and lower odds of percutaneous coronary intervention (aOR, 0.95 [0.92–0.99]; p=0.02), and coronary artery bypass graft (aOR, 0.90 [0.85–0.97]; p<0.01).
Conclusions
We found a significant decline in AMI hospitalizations and use of revascularization, with higher in-hospital mortality, during the early COVID-19 pandemic period (2020) compared with the pre-pandemic period (2019). Further research into the factors associated with increased mortality could help with preparedness in future pandemics.

Keyword

COVID-19; Coronavirus; Acute coronary syndromes; Myocardial infarction; Percutaneous coronary intervention

Figure

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  Figure 1 Trends in COVID-19 US Hospitalizations in 2020.COVID-19 = coronavirus disease 2019.

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  Figure 2 Trends and outcomes of STEMI hospitalizations. (A) number of STEMI hospitalizations, (B) in-hospital mortality, and (C) coronary angiography, PCI, and CABG procedure utilization.CABG = coronary artery bypass graft; PCI = percutaneous coronary intervention; STEMI = ST-segment elevation myocardial infarction

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  Figure 3 Trends and outcomes of NSTEMI hospitalizations (A) number of NSTEMI hospitalizations, (B) in-hospital mortality and (C) coronary angiography, PCI, and CABG procedure utilization.CABG = coronary artery bypass graft; NSTEMI = non-ST-segment elevation myocardial infarction; PCI = percutaneous coronary intervention

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  Figure 4 Forest plots showing the adjusted outcomes of (A) AMI, (B) STEMI, and (C) NSTEMI hospitalizations in 2020 vs. 2019.AMI = acute myocardial infarction; NSTEMI = non-ST-segment elevation myocardial infarction; STEMI = ST-segment elevation myocardial infarction

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