Impact of the COVID-19 pandemic on the incidence and prognosis of acute myocardial infarction - a single-center restrospective analysis

Introduction: COVID-19 pandemic has led to a signifi cant change in the incidence and prognosis of acute myocardial infarction (AMI) by indirect and direct mechanisms. Aim: To assess the impact of the COVID-19 pandemic on the incidence and prognosis of AMI. Material and methods: We performed a retrospective analysis of consecutive patients with AMI (STEMI and NSTEMI) during two time periods – the complete lockdown in Bulgaria and one of the waves of the pandemic. We compared patients’ risk profi le, index event, investigations and treatment to a control group from the pre-pandemic period. Results: During the fi rst period we included 52 patients with AMI without COVID-19 and compared them to a control group of 66 patients. We found a decrease primarily in the number of patients with STEMI. The scores for assessing diseaseseverity (GRACE, APACHE II, SOFA) were higher in 2020 compared to the pre-pandemic period. More patients presented with acute congestive heart failure, mortality was similar. During the second period we included 83 patients, 21 of them with COVID-19 infection. System delay was increased in all patients. Disease severity scores and baseline troponin were higher especially in the COVID-19 group. In-hospital mortality was substantially higher in patients with COVID-19 compared to controls (23,8% versus 9%, р = 0,0375), probably due to increased incidence of cardiogenic shock and need for mechanical ventilation. Conclusion: During the complete lockdown there was a reduction in the number of patients admitted with AMI, higher incidence of acute congestive heart failure and similar mortality. During one of the waves of the pandemic we found a signifi cant increase in system delay, not exceeding the recommended time frame of 120 minutes, and in disease severity in all patients. Concomitant COVID-19 infection was associated with higher in-hospital mortality due to increased incidence of cardiogenic shock and need for mechanical ventilation.