Abstract Body (Do not enter title and authors here):
Background:
Acute MI is associated with significant immediate mortality however a second wave of morbidity and mortality arises from mechanical complications which include papillary muscle rupture (PMR), ventricular septal defect (VSD), left ventricular free wall rupture (FWR) and left ventricular aneurysm (LVA). Reports from Europe have suggested an increased incidence of mechanical complications of MI in the covid era due to delays in care and strained systems. This study aims to evaluate the impact of COVID-19 on mechanical complications of STEMI in the US using the national inpatient sample database (NIS).
Methodology:
We performed a retrospective cohort study using the 2021 NIS database, a survey weighted, nationwide sample with over 6 million observations across the US. Patients undergoing PCI for STEMI (identified using ICD-10 codes) comprised our patient population. The primary outcome was a composite of the 4 mechanical complications. We also assessed the incidence of pericardial tamponade separately. Individual incidences for each of the mechanical complications between covid positive and negative cases were compared using Chi square test. Logistic regression models and propensity score matching were employed to assess associations and to control for confounders.
Results:
Among 292,834 STEMI patients undergoing PCI, 0.3%(n=900) developed mechanical complications. Incidences for PMR, VSD, FWR and LVA were 0.03%(n=95), 0.04%(n=130), 0.034%(n=100), 0.2%(n=595) respectively. 0.17% (n=505) developed cardiac tamponade. When stratified by COVID status the combined incidence of all mechanical complications in COVID positive group was twice as high (0.3% vs 0.79%, p=0.0048) while tamponade was seen three times as frequently (0.17% vs 0.5%, p=0.01). PMR (0.03% vs 0.2%, p=0.003) and LVA (0.02% vs 0.05%, p=0.03) were seen significantly more frequently in COVID positive group. FWR (p=0.56) and VSD (p=0.4) were not statistically different between the two groups. Logistic regression after propensity matching revealed elevated OR for all mechanical complications (OR 2.6, p=0.007), PMR (OR 6.7, p=0.011), tamponade (OR 2.9, p=0.017), and LVA (OR 2.5, p=0.04).
Conclusion:
Although rare, mechanical complications of STEMI are seen more commonly with concomitant COVID-19 infection. The risk of Pzpillary Muscle Rupture is most substantially increased. This underscores the importance of vigilance in patients with concomitant infection and during COVID surges.