Abstract

OBJECTIVES

Post-acute myocardial infarction mechanical complications (post-AMI MCs) represent rare but life-threatening conditions, including free-wall rupture, ventricular septal rupture and papillary muscle rupture. During the coronavirus disease-19 (COVID-19) pandemic, an overwhelming pressure on healthcare systems led to delayed and potentially suboptimal treatments for time-dependent conditions. As AMI-related hospitalizations decreased, limited information is available whether higher rates of post-AMI MCs and related deaths occurred in this setting. This study was aimed to assess how COVID-19 in Europe has impacted the incidence, treatment and outcome of MCs.

METHODS

The CAUTION-COVID19 study is a multicentre retrospective study collecting 175 patients with post-AMI MCs in 18 centres from 6 European countries, aimed to compare the incidence of such events, related patients’ characteristics, and outcomes, between the first year of pandemic and the 2 previous years.

RESULTS

A non-significant increase in MCs was observed [odds ratio (OR) = 1.15, 95% confidence interval (CI) 0.85–1.57; P = 0.364], with stronger growth in ventricular septal rupture diagnoses (OR = 1.43, 95% CI 0.95–2.18; P = 0.090). No significant differences in treatment types and mortality were found between the 2 periods. In-hospital mortality was 50.9% and was higher for conservatively managed cases (90.9%) and lower for surgical patients (44.0%). Patients admitted during COVID-19 more frequently had late-presenting infarction (OR = 2.47, 95% CI 1.24–4.92; P = 0.010), more stable conditions (OR = 2.61, 95% CI 1.27–5.35; P = 0.009) and higher EuroSCORE II (OR = 1.04, 95% CI 1.01–1.06; P = 0.006).

CONCLUSIONS

A non-significant increase in MCs incidence occurred during the first year of COVID-19, characterized by a significantly higher rate of late-presenting infarction, stable conditions and EuroSCORE-II if compared to pre-pandemic data, without affecting treatment and mortality.

Details

Title
Impact of COVID-19 on incidence and outcomes of post-infarction mechanical complications in Europe
Author
Ronco, Daniele 1   VIAFID ORCID Logo  ; Matteucci, Matteo 1   VIAFID ORCID Logo  ; Justine Mafalda Ravaux 1 ; Kowalewski, Mariusz 1 ; Massimi, Giulio 1 ; Torchio, Federica 2 ; Trumello, Cinzia 3 ; Naito, Shiho 4 ; Bonaros, Nikolaos 5   VIAFID ORCID Logo  ; De Bonis, Michele 3   VIAFID ORCID Logo  ; Fina, Dario 1 ; Kowalówka, Adam 6   VIAFID ORCID Logo  ; Deja, Marek 7 ; Jiritano, Federica 1   VIAFID ORCID Logo  ; Giuseppe Filiberto Serraino 8 ; Kalisnik, Jurij Matija 9 ; De Vincentiis, Carlo 10   VIAFID ORCID Logo  ; Ranucci, Marco 11   VIAFID ORCID Logo  ; Fischlein, Theodor 9   VIAFID ORCID Logo  ; Russo, Claudio Francesco 12 ; Carrozzini, Massimiliano 12   VIAFID ORCID Logo  ; Boeken, Udo 13 ; Kalampokas, Nikolaos 13 ; Golino, Michele 2 ; De Ponti, Roberto 2 ; Pozzi, Matteo 14 ; Obadia, Jean-François 14 ; Thielmann, Matthias 15   VIAFID ORCID Logo  ; Scrofani, Roberto 16 ; Blasi, Stefania 17 ; Troise, Giovanni 17 ; Antona, Carlo 16 ; De Martino, Andrea 18   VIAFID ORCID Logo  ; Falcetta, Giosuè 18 ; Guglielmo Actis Dato 19 ; Severgnini, Paolo 20 ; Musazzi, Andrea 21 ; Lorusso, Roberto 1   VIAFID ORCID Logo 

1  Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre , Maastricht, Netherlands 
2  Department of Medicine and Surgery, Circolo Hospital, University of Insubria , Varese, Italy 
3  Cardiothoracic Surgery Department, San Raffaele University Hospital , Milan, Italy 
4  Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg , Hamburg, Germany 
5  Department of Cardiac Surgery, Medical University of Innsbruck , Innsbruck, Austria 
6  Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum , Bydgoszcz, Poland 
7  Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice , Katowice, Poland 
8  Department of Experimental and Clinical Medicine, “Magna Graecia” University of Catanzaro , Catanzaro, Italy 
9  Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University , Nuremberg, Germany 
10  Cardiac Surgery Unit, IRCCS Policlinico San Donato , San Donato Milanese, Italy 
11  Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato , San Donato Milanese, Italy 
12  Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital , Milan, Italy 
13  Department of Cardiovascular Surgery, University Hospital Düsseldorf, Heinrich Heine University , Düsseldorf, Germany 
14  Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital , Lyon, France 
15  Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University of Duisburg-Essen , Essen, Germany 
16  Cardiac Surgery Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico , Milan, Italy 
17  Cardiac Surgery Unit, Poliambulanza Foundation Hospital , Brescia, Italy 
18  Section of Cardiac Surgery, University Hospital , Pisa, Italy 
19  Cardiac Surgery Department, Mauriziano Hospital , Turin, Italy 
20  Department of Biotechnology and Sciences of Life, Circolo Hospital, University of Insubria , Varese, Italy 
21  Cardiac Surgery Unit, Circolo Hospital , Varese, Italy 
Publication year
2023
Publication date
Dec 2023
Publisher
Oxford Publishing Limited (England)
e-ISSN
2753670X
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1093/icvts/ivad198
ProQuest document ID
3191828892
Copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.