Coronavirus | May 22, 2024 | FREE
Most ACP Hospitalist content is available exclusively to ACP Members. This article is free to the public.

Factors identified to predict risk of type 2 MI in patients hospitalized with COVID-19

Patients who were on antihyperglycemic or anticoagulant medications before admission were less likely to be among the 2.2% of patients who had a type 2 non-ST-segment elevation myocardial infarction (MI) while hospitalized with COVID-19, a retrospective study found.

Incidence, predictors, and outcomes of type 2 non-ST-segment elevation myocardial infarction (MI) in patients hospitalized with COVID-19 were evaluated by a recent study.

Researchers used the national American Heart Association COVID-19 Cardiovascular Disease Quality Improvement Registry to retrospectively match cases of type 2 MI with controls by age, sex, race, and body mass index. From January 2020 through May 2021, type 2 MI occurred in 709 (2.2%) of the 32,015 COVID-19 patients in the database. A total of 579 cases were matched to 2,171 controls for the study (mean age, 70 years; 43% female). Results were published by the Journal of the American Heart Association on May 10.

Risk of type 2 MI was higher in patients with known coronary artery disease, heart failure, chronic kidney disease, or hypertension. Patients on Medicaid were at elevated risk compared to those with other payers, and higher heart rate at admission was directly associated with risk of type 2 MI (odds ratio [OR], 1.16 [95% CI, 1.10 to 1.22] per 10 beats; P<0.001). The only preadmission predictors of reduced risk were use of antihyperglycemic medications (OR, 0.76 [95% CI, 0.60 to 0.95]; P=0.018) or anticoagulants (OR, 0.72 [95% CI, 0.54 to 0.95]; P=0.022). Patients with type 2 MI had higher morbidity and mortality (hazard ratio, 1.40 [95% CI, 1.13 to 1.74]; P=0.002).

The study authors noted that the worse outcomes in patients with type 2 MI are not surprising. "This may be in the context of more severe COVID-19 infection, given that cases had higher admission heart rates, higher incidence of abnormal chest radiograph, and higher (modified) COVID-19 severity scores," they wrote. Similarly, the decreased risk in patients already on anticoagulants fit with existing knowledge that COVID-19 causes a hypercoagulable state and systemic endothelial tissue injury.

The finding of lower risk of type 2 MI with diabetes medications is more interesting, according to the study authors, and matches previous findings of lower mortality rates in patients with type 2 diabetes and COVID-19 who took metformin, a glucagon-like peptide-1 receptor agonist, or a sodium-glucose cotransporter-2 inhibitor before admission.

"This observation may have particular relevance given that many studies show higher morbidity and mortality in those with type 2 diabetes and COVID-19 infection," the authors wrote. "Outpatient antihyperglycemic medication use may be protective against both [type 2] MI and mortality in hospitalized patients with COVID-19, and this exploratory finding warrants further investigation in experimental studies, given mechanistic plausibility of some of these agents."