Incidence of Stress Cardiomyopathy During the Coronavirus Disease 2019 Pandemic
Incidence of Stress Cardiomyopathy During the Coronavirus Disease 2019 Pandemic
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DOI：
10.1001/jamanetworkopen.2020.14780
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发表时间：
2020-07-09
影响因子：
13.8
通讯作者：
Reed, Grant W.
中科院分区：
文献类型：
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作者：
Jabri, Ahmad;Kalra, Ankur;Reed, Grant W.
重要性2019冠状病毒病（COVID-19）大流行给人们的生活带来了严重的心理、社会和经济压力。目前尚不清楚大流行的压力是否与压力性心肌病发病率的增加有关。目的确定与疫情前相比，COVID-19大流行期间应激性心肌病的发病率和结局。设计、设置和参与者这项回顾性队列研究在俄亥俄州东北部克利夫兰诊所卫生系统的2家医院的具有直接经皮冠状动脉介入治疗能力的心导管实验室进行，研究了接受冠状动脉造影术的急性冠状动脉综合征患者的应激性心肌病（也称为Takotsubo综合征）的发生率。将2020年3月1日至4月30日期间在COVID-19大流行期间就诊的患者与在大流行之前在4个不同时间线（2018年3月至4月、2019年1月至2月、2019年3月至4月和2020年1月至2月）就诊的4个急性冠状动脉综合征患者对照组进行比较。数据分析于2020年5月进行。根据患者出现与COVID-19疫情相关的临床表现的日期，将患者分为5组。主要结局和指标应激性心肌病的发病率。结果1914例急性冠脉综合征患者中，（中位[四分位距]年龄，67 [59-74]; 1094例[66.1%]男性）在COVID-19前期间就诊（2018年3 - 4月390例，2019年1 - 2月309例，2019年3 - 4月679例，2020年1 - 2月278例），258例患者（中位[四分位数间距]年龄为67 [57-75]; 175例[67.8%]男性）在COVID-19大流行期间（即2020年3月至4月）就诊。在COVID-19期间，应激性心肌病的发病率显著增加，共有20例应激性心肌病患者（发病比例为7.8%），而大流行前的时间线为5至12例应激性心肌病患者（发病比例范围为1.5%-1.8%）。COVID-19大流行期间与大流行前合并期间的比率为4.58（95%CI，4.11-5.11; P < .001）。在COVID-19大流行期间，所有患者的COVID-19逆转录聚合酶链反应检测结果均为阴性。在COVID-19大流行期间，患有应激性心肌病的患者的中位数（四分位距）住院时间与大流行前住院时间相比（（2019冠状病毒病期间：8 [6-9]天; 2018年3月至4月：4 [3-4]天; 2019年1月至2月：5 [3-6]天; 2019年3月至4月：4 [4-8]天; 2019年1月至2月：5 [4-5]天; P = .006）。COVID-19期间和总体COVID-19前期间的死亡率（分别为1例患者[5.0%] vs 1例患者[3.6%]; P = 0.81）或30天再住院率（分别为4例患者[22.2%] vs 6例患者[21.4%]; P = 0.90）无显著差异。结论和相关性这项研究发现，与大流行前相比，COVID-19大流行期间应激性心肌病的发病率显著增加。问题与2019冠状病毒病（COVID-19）相关的心理、社会和经济压力是否与应激性心肌病的发病率相关？这项队列研究纳入了1914名急性冠状动脉综合征患者，将COVID-19大流行期间就诊的患者与大流行前4个时间线上就诊的患者进行比较，发现COVID-19大流行期间应激性心肌病的发病率显著增加，为7. 8%，而大流行前的发病率为1. 5%至1. 8%。这些研究结果表明，与COVID-19大流行相关的心理，社会和经济压力与应激性心肌病发病率增加有关。这项队列研究比较了2019年冠状病毒病大流行期间与大流行前时间点在俄亥俄州2家医院就诊的急性冠状动脉综合征患者的应激性心肌病发病率。
Importance The coronavirus disease 2019 (COVID-19) pandemic has resulted in severe psychological, social, and economic stress in people's lives. It is not known whether the stress of the pandemic is associated with an increase in the incidence of stress cardiomyopathy. Objective To determine the incidence and outcomes of stress cardiomyopathy during the COVID-19 pandemic compared with before the pandemic. Design, Setting, and Participants This retrospective cohort study at cardiac catheterization laboratories with primary percutaneous coronary intervention capability at 2 hospitals in the Cleveland Clinic health system in Northeast Ohio examined the incidence of stress cardiomyopathy (also known as Takotsubo syndrome) in patients presenting with acute coronary syndrome who underwent coronary arteriography. Patients presenting during the COVID-19 pandemic, between March 1 and April 30, 2020, were compared with 4 control groups of patients with acute coronary syndrome presenting prior to the pandemic across 4 distinct timelines: March to April 2018, January to February 2019, March to April 2019, and January to February 2020. Data were analyzed in May 2020. Exposures Patients were divided into 5 groups based on the date of their clinical presentation in relation to the COVID-19 pandemic. Main Outcomes and Measures Incidence of stress cardiomyopathy. Results Among 1914 patient presenting with acute coronary syndrome, 1656 patients (median [interquartile range] age, 67 [59-74]; 1094 [66.1%] men) presented during the pre-COVID-19 period (390 patients in March-April 2018, 309 patients in January-February 2019, 679 patients in March-April 2019, and 278 patients in January-February 2020), and 258 patients (median [interquartile range] age, 67 [57-75]; 175 [67.8%] men) presented during the COVID-19 pandemic period (ie, March-April 2020). There was a significant increase in the incidence of stress cardiomyopathy during the COVID-19 period, with a total of 20 patients with stress cardiomyopathy (incidence proportion, 7.8%), compared with prepandemic timelines, which ranged from 5 to 12 patients with stress cardiomyopathy (incidence proportion range, 1.5%-1.8%). The rate ratio comparing the COVID-19 pandemic period to the combined prepandemic period was 4.58 (95% CI, 4.11-5.11; P < .001). All patients during the COVID-19 pandemic had negative reverse transcription-polymerase chain reaction test results for COVID-19. Patients with stress cardiomyopathy during the COVID-19 pandemic had a longer median (interquartile range) hospital length of stay compared with those hospitalized in the prepandemic period (COVID-19 period: 8 [6-9] days; March-April 2018: 4 [3-4] days; January-February 2019: 5 [3-6] days; March-April 2019: 4 [4-8] days; January-February: 5 [4-5] days; P = .006). There were no significant differences between the COVID-19 period and the overall pre-COVID-19 period in mortality (1 patient [5.0%] vs 1 patient [3.6%], respectively; P = .81) or 30-day rehospitalization (4 patients [22.2%] vs 6 patients [21.4%], respectively; P = .90). Conclusions and Relevance This study found that there was a significant increase in the incidence of stress cardiomyopathy during the COVID-19 pandemic when compared with prepandemic periods.Question Is psychological, social, and economic stress associated with coronavirus disease 2019 (COVID-19) associated with the incidence of stress cardiomyopathy? Findings This cohort study included 1914 patients with acute coronary syndrome to compare patients presenting during the COVID-19 pandemic with patients presenting across 4 timelines prior to the pandemic and found a significantly increased incidence of 7.8% of stress cardiomyopathy during the COVID-19 pandemic, compared with prepandemic incidences that ranged from 1.5% to 1.8%. Meaning These findings suggest that psychological, social, and economic stress related to the COVID-19 pandemic was associated with an increased incidence of stress cardiomyopathy.This cohort study compares the incidence of stress cardiomyopathy among patients presenting with acute coronary syndrome at 2 Ohio hospitals during the coronavirus disease 2019 pandemic vs prepandemic time points.