Epidemiological study of the impact of COVID-19 on the course of myocardial infarction

Objective of the Study. To assess the comparative impact of COVID-19 on the course of acute myocardial infarction (AMI) in Tomsk from 2019 to 2022. Material and methods. This study utilized data from the information-analytical database of the epidemiological program “Acute Myocardial Infarction Registry” (AMIR). During the analyzed period (2019–2022), 3,617 cases of AMI were registered, including 147 (4.1%) episodes where the disease occurred against a background of verified and confirmed COVID-19. All identified cases occurred while the patient was in a non-profile hospital (in respiratory hospitals specifically opened for treating individuals with confirmed or suspected COVID-19). For comparative analysis, all registered patients with AMI were divided into two groups: the first group included 147 patients with confirmed COVID-19 (COV+) and the second group included 3,617 individuals without COVID-19 (COV−). Results. In terms of gender, the differences between the analyzed groups were not significant. In the first group, individuals over 60 years old predominated — 94.2%, while in the second group, such patients accounted for 73.7% (p < 0.001). Atypical manifestations of AMI were recorded in 58.5% (first group) and 24.8% (second group) of cases respectively (p < 0.001). Among the atypical manifestations of the disease in patients of the first group, the asthmatic variant predominated — more than 70% (73.5%) of cases. Patients in the first group predominantly had exertional angina, diabetes mellitus, and hypertension. Despite all patients in the first group being in nonprofi le hospitals (respiratory hospitals) at the time of AMI onset, 78.6% were transferred to the angiography unit of specialized departments, where they underwent coronary ventriculography (CVG) and stenting of coronary arteries. They were then returned to the non-profile hospital for further treatment. Regarding CVG data, no signifi cant differences between the analyzed groups were found. The most common cause of death among patients in both groups was acute left ventricular failure (ALVF), which was significantly more common in patients of the first group. Since the number of analyzed cases of AMI combined with COVID-19 was small, the degree of impact of the new coronavirus infection on the epidemiology of AMI was also found to be insignificant. However, it should be noted that the mortality rate in the group of AMI patients against a background of COVID-19 was very high, averaging 86.9%. Conclusions. 1. Currently, the impact of COVID-19 on morbidity and mortality from acute myocardial infarction among the population of Tomsk has proven to be insignificant. 2. Nevertheless, it is essential to acknowledge the negative influence of COVID-19 on mortality and the immediate course of acute coronary pathology, affecting both age-related and clinical-anamnestic characteristics. 3. The combination of acute myocardial infarction with COVID-19 is often accompanied by necrotic damage to large areas of myocardium and is characterized by very high mortality.

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