Treatment and outcomes of mechanical complications of acute myocardial infarction during the Covid-19 era: A comparison with the pre-Covid-19 period. A systematic review and meta-analysis

Author:

Spadaccio Cristiano1,Pisani Angelo2,Salsano Antonio34,Nenna Antonio5,Fardman Alexander67,D’Alessandro David1,Santini Francesco34,Gaudino Mario F. L.8,Sundt Thoralf M.1,Rose David9

Affiliation:

1. Cardiac Surgery, Massachusetts General Hospital (MGH), Harvard Medical School , Boston , United States of America

2. Cardiac Surgery, Pineta Grande Hospital, Castel Volturno , Naples , Italy

3. Division of Cardiac Surgery, IRCCS Ospedale Policlinico San Martino , Genoa , Italy

4. DISC Department, University of Genoa , L.go Rosanna Benzi, 10, 16143 , Genoa , Italy

5. Division of Cardiac Surgery, Università Campus Bio-Medico di Roma , Rome , Italy

6. Lev Leviev Heart and Vascular Center, Sheba Medical Center , Tel Hashomer , Israel

7. Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel

8. Cardiothoracic Surgery, Weill Cornell Medicine , New York , United States

9. Cardiac Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital , Blackpool , United Kingdom

Abstract

Abstract This study aims to compare treatments and outcomes of mechanical complications of acute myocardial infarction (MI) during the Covid-19 and in the pre-Covid-19 era. Electronic databases have been searched for MI mechanical complications during the Covid-19 era and in the previous period from January 1998 to January 2020 (pre-Covid-19 era), until October 2021. To perform a quantitative analysis of non-comparative series, a meta-analysis of proportion has been conducted. Early mortality after surgical treatment was 15.0% while it was significantly higher after conservative treatment (62.4%) (P = 0.026). Early mortality after surgical treatment was seemingly higher in the pre-Covid-19 era but the difference did not reach statistical significance (15.0% vs 38.9%; P = 0.13). Mortality in patients treated conservatively, or turned down for surgery, was lower during the Covid-19 pandemic (62.4% vs 97.7%; P = 0.001). The crude mean prevalence of the use rate of conservative or surgical treatment across the studies during Covid-19 and in the pre-Covid-19 era was comparable. The current increased incidence of MI mechanical complications might be a consequence of delayed presentation or restricted access to hospital facilities. Despite the general negative impact of Covid-19 on cardiac surgery volumes and outcomes and the apparent increase of the incidence of MI complications, the outcomes of their surgical and clinical treatment seem not to have been affected during the pandemic.

Publisher

Walter de Gruyter GmbH

Subject

General Medicine

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