Prevalence, Predictors, and Outcomes of Type 2 NSTEMI in Hospitalized Patients With COVID‐19

Abstract

Background Data on the incidence of type 2 non–ST‐segment–elevation myocardial infarction (T2MI) in hospitalized patients with COVID‐19 has been limited to single‐center studies. Given that certain characteristics, such as obesity and type 2 diabetes, have been associated with higher mortality in COVID‐19 infections, we aimed to define the incidence of T2MI in a national cohort and identify pre‐hospital patient characteristics associated with T2MI in hospitalized patients with COVID‐19. Methods and Results Using the national American Heart Association COVID‐19 Cardiovascular Disease Quality Improvement Registry, we performed a retrospective 4:1 matched (age, sex, race, and body mass index) analysis of controls versus cases with T2MI. We performed (1) conditional multivariable logistic regression to identify predictive pre‐hospital patient characteristics of T2MI for patients hospitalized with COVID‐19 and (2) stratified proportional hazards regression to investigate the association of T2MI with morbidity and mortality. From January 2020 through May 2021, there were 709 (2.2%) out of 32 015 patients with T2MI. Five hundred seventy‐nine cases with T2MI were matched to 2171 controls (mean age 70; 43% female). Known coronary artery disease, heart failure, chronic kidney disease, hypertension, payor source, and presenting heart rate were associated with higher odds of T2MI. Anti‐hyperglycemic medication and anti‐coagulation use before admission were associated with lower odds of T2MI. Those with T2MI had higher morbidity and mortality (hazard ratio, 1.40 [95% CI, 1.13–1.74]; P =0.002). Conclusions In hospitalized patients with COVID‐19, those with a T2MI compared with those without had higher morbidity and mortality. Outpatient anti‐hyperglycemic and anti‐coagulation use were the only pre‐admission factors associated with reduced odds of T2MI.