Outcomes of COVID-19-positive acute coronary syndrome patients: A multisource electronic healthcare records study from England.
Outcomes of COVID-19-positive acute coronary syndrome patients: A multisource electronic healthcare records study from England.
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DOI：
10.1111/joim.13246
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发表时间：
2021-07
影响因子：
11.1
通讯作者：
Mamas MA
中科院分区：
文献类型：
--
作者：
Rashid M;Wu J;Timmis A;Curzen N;Clarke S;Zaman A;Nolan J;Shoaib A;Mohamed MO;de Belder MA;Deanfield J;Gale CP;Mamas MA
患有基础心血管疾病和2019冠状病毒病（COVID-19）感染的患者的发病率和死亡率风险增加。本研究旨在描述急性冠状动脉综合征（ACS）和COVID-19感染住院患者的临床特征和结局。这项观察性队列研究使用来自英格兰所有急性NHS医院的多样本数据进行。纳入了2020年3月1日至5月31日期间诊断为ACS伴或不伴COVID-19感染的所有连续住院患者。主要结局为住院和30天死亡率。在研究期间，共有12958例患者因ACS住院，其中517例（4.0%）为COVID-19阳性，更有可能出现非ST段抬高急性心肌梗死。与非COVID-19 ACS组相比，COVID-19 ACS组通常年龄较大，为亚洲黑人和少数民族，共病率较高，且具有不利的临床特征，如心肌肌钙蛋白升高、肺水肿、心源性休克和左心室收缩功能差。他们不太可能接受有创冠状动脉造影（67.7% vs 81.0%）、经皮冠状动脉介入治疗（PCI）（30.2% vs 53.9%）和双重抗血小板药物治疗（76.3% vs 88.0%）。校正所有基线差异后，与非COVID-19 ACS患者相比，COVID-19 ACS患者的住院死亡率（校正比值比（aOR）：3.27; 95%置信区间（CI）：2.41-4.42）和30天死亡率（aOR：6.53; 95% CI：5.1-8.36）更高。在英格兰，4%的ACS住院患者存在COVID-19感染，并且与指南推荐的治疗率较低和显著的死亡风险相关。
Patients with underlying cardiovascular disease and coronavirus disease 2019 (COVID‐19) infection are at increased risk of morbidity and mortality. This study was designed to characterize the presenting profile and outcomes of patients hospitalized with acute coronary syndrome (ACS) and COVID‐19 infection. This observational cohort study was conducted using multisource data from all acute NHS hospitals in England. All consecutive patients hospitalized with diagnosis of ACS with or without COVID‐19 infection between 1 March and 31 May 2020 were included. The primary outcome was in‐hospital and 30‐day mortality. A total of 12 958 patients were hospitalized with ACS during the study period, of which 517 (4.0%) were COVID‐19‐positive and were more likely to present with non‐ST‐elevation acute myocardial infarction. The COVID‐19 ACS group were generally older, Black Asian and Minority ethnicity, more comorbid and had unfavourable presenting clinical characteristics such as elevated cardiac troponin, pulmonary oedema, cardiogenic shock and poor left ventricular systolic function compared with the non‐COVID‐19 ACS group. They were less likely to receive an invasive coronary angiography (67.7% vs 81.0%), percutaneous coronary intervention (PCI) (30.2% vs 53.9%) and dual antiplatelet medication (76.3% vs 88.0%). After adjusting for all the baseline differences, patients with COVID‐19 ACS had higher in‐hospital (adjusted odds ratio (aOR): 3.27; 95% confidence interval (CI): 2.41–4.42) and 30‐day mortality (aOR: 6.53; 95% CI: 5.1–8.36) compared to patients with the non‐COVID‐19 ACS. COVID‐19 infection was present in 4% of patients hospitalized with an ACS in England and is associated with lower rates of guideline‐recommended treatment and significant mortality hazard.
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