COVID-19 Increases Mortality Risk in Patients With Acute Coronary Syndrome

doctor holding oxygen ambu bag over patient given oxygen to patient by intubation tube in ICU/Emergency room
The researchers’ aim was to determine the demographics, angiographic findings, and in-hospital outcomes of COVID-19 ACS patients and compare these with pre-COVID-19 cohorts.

Patients with acute coronary syndrome (ACS) and a COVID-19 infection are at increased risk for in-hospital mortality, according to an analysis of a multicenter international registry published in Journal of the American College of Cardiology.

An international registry was created by researchers at University Hospitals of Leicester and University of Glasgow. Data were sourced from 55 international centers located in Europe (75.3%), South America (11.1%), Asia (6.6%), Africa (4.7%), and North America (2.2%). In-hospital mortality among patients with ACS and COVID-19 were compared with historical data collected between 2018 and 2019.

Patients (N=265) had a mean age of 64.9±12.9 years, and 75.5% were men. Of these patients, 66.2% had hypertension, 54.1% had hyperlipidemia, and 36.2% had diabetes. Their mean body mass index was 27.5±4.7.

A total of 144 patients had ST-segment elevation myocardial infarction (STEMI) and 121 had non-ST-segment elevation ACS (NSTE-ACS). The COVID-STEMI and COVID-NSTE-ACS cohorts were younger (P =.018; P =.005) and more had hypertension (both, P <.001), hyperlipidemia (both, P <.001), diabetes (P <.001; P =.048), and chronic kidney disease (both, P <.001) compared with historical data from patients with STEMI and NSTE-ACS, respectively.

Compared with historical data, the COVID-STEMI and COVID-NSTE-ACS cohorts had higher mortality (22.9% vs 5.7%; P <.001 and 6.6% vs 1.2%; P <.001), bleeding (2.8% vs 0.26%; P <.001 and 2.5% vs 0.12%; P =.006), stroke (2.1% vs 0.14%; P =.002 and 0.8% vs 0.05%; P =.067), cardiogenic shock (20.1% vs 8.7%; P <.001 and 5.0% vs 1.4%; P =.007), longer time delay from symptom onset to hospital admission (median, 339 vs 173 min; P <.001 and 417 vs 295 min; P =.012), and longer in-patient stay (median, 6.4 vs 3.0 days; P <.001 and 6.9 vs 5.0 days; P <.001).

Among a propensity-matched subgroup, mortality was increased among all patients with COVID-19 (adjusted odds ratio [aOR], 3.33; 95% CI, 2.04-5.42) and the noncardiogenic shock COVID-19 subgroup (aOR, 4.16; 95% CI, 2.33-7.44).

Mortality-related time to ischemia for every 10 minutes was increased among all patients with COVID-19 (OR, 1.10; 95% CI, 1.01-1.19) and the cardiogenic shock COVID-19 subgroup (OR, 1.25; 95% CI, 1.09-1.45).

This study may have been limited by including many patients (29.1%) who tested negative for COVID-19 but had abnormal lung imaging findings.

These data indicated that patients with ACS and COVID-19 presented later and were at increased risk for in-hospital mortality than patients without COVID-19.

“Clear and simple public health messages for patients to present expeditiously to the hospital when they first experience symptoms of ACS are required during this and

future pandemics.,” the study authors concluded.

Disclosure: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please refer to the original reference for a full list of authors’ disclosures.


Kite TA, Ludman PF, Gale CP, et al; on behalf of theInternational COVID-ACS Registry Investigators. International Prospective Registry of Acute Coronary Syndromes in Patients With COVID-19. J Am Coll Cardiol. 2021;77(20):2466-2476. doi:10.1016/j.jacc.2021.03.309