Covid-19 diagnosis and mortality in patients with acute myocardial infarction admitted in italy during the national outbreak

Abstract Background and objective: There are limited data on the clinical impact of Covid–19 in patients with acute myocardial infarction (AMI). Aim of this work is to assess the impact of Covid–19 infection on mortality in AMI patients admitted during the national outbreak in Italy. Methods Retrospective nationwide cohort study enrolling consecutive AMI patients admitted between March,11st and May 3rd, 2020 (national outbreak) and the equivalent periods of the previous 5 years in Italy. The main outcomes were 30–day and 6–month all–cause mortality. Results The actual number of AMI admission during the 2020 outbreak in Italy was significantly reduced as compared to that expected based on the trend of the previous 5 years (STEMI: 4048 vs 5523, p<0.0001; NSTEMI: 4981 vs 8633, p<0.0001). A Covid–19 diagnosis was reported in 4.2% of STEMI and 3.5% of NSTEMI patients. In STEMI patients the 2020 expected rate of 30–day and 6–month mortality was 9.2% and 12.6%, compared to observed rates of 10.8% (p=0.016) and 14.4% (p=0.017), respectively. In NSTEMI patients the 30–day and 6–month expected mortality rates in 2020 were 6.5% and 12.2%, compared to observed rates of 8.3% (p=0.001) and 13.6% (p=0.041), respectively. Excluding patients diagnosed with Covid–19, the mortality rates become consistent with the trend of the previous 5–year for STEMI, but remain higher for NSTEMI. After multivariate adjustment, diagnosis of Covid–19 resulted an independent predictor of both 30–day mortality (OR=4.7, p<0.0001 for STEMI; OR=4.5, p<0.0001 for NSTEMI) and 6–month mortality (OR=3.6, p<0.0001 for STEMI; OR=3.8, p<0.0001 for NSTEMI). Conclusion During the 2020 national outbreak in Italy, a concomitant diagnosis of Covid–19 was associated with a significantly higher rate of mortality in both STEMI and NSTEMI patients. Excluding patients diagnosed with Covid–19, the mortality rates become consistent with the previous 5–year trend for STEMI, while they remain higher for NSTEMI.