One-year outcomes of invasively managed acute coronary syndrome patients with COVID-19.
Tufan Çınar, Faysal Şaylık, Tayyar Akbulut and 5 others
PMID 35092905WHAT IT FOUND
ACS patients with COVID-19 who underwent angiography were more likely to die within one year than ACS patients without COVID-19 or pre-pandemic ACS patients.
They also had higher in-hospital and 30-day mortality.
Key findings
01One-year mortality was 20 (21.3%) among ACS patients with COVID-19, 9 (6.5%) among ACS patients without COVID-19, and 29 (6.9%) among pre-COVID-19 ACS patients.
02After adjustment, ACS with COVID-19 was the only independent predictor of one-year mortality, with a reported hazard ratio of 2.902 (95% CI 1.211-6.824, P=0.018).
03In-hospital mortality was 21 (17.6%) with ACS and COVID-19, 9 (6%) with ACS without COVID-19, and 19 (4.2%) pre-COVID-19; 30-day mortality was 25 (21%), 11 (7.4%), and 32 (7.1%), respectively.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was retrospective, non-randomized, single-center, and open-label, so it cannot prove that COVID-19 caused the higher mortality. Patient selection before ACS was questionable and selection bias may be present. Only all-cause mortality was assessed; other outcomes were not evaluated because of missing data. Even with multivariable adjustment, residual confounding may remain because the groups differed in illness severity markers, laboratory values, and time to intervention. The paper describes a limited number of ACS patients, despite stating the sample size had adequate power.
Declared interests
All authors declared no conflict of interest. The supplied text does not state a funding source.
The easy way to misread this
Do not read the higher mortality as proof that COVID-19 alone caused death or that more aggressive treatments such as prolonged dual antiplatelet therapy, higher-dose statin, or earlier beta blocker or renin angiotensin aldosterone system blocker titration will improve survival. This was a retrospective observational comparison of patient groups, not a treatment trial, and the authors state residual confounding and selection bias may remain.