Negative impact of the combination of acute myocardial infarction with active COVID-19 and wartime-associated factors on the course of the long-term post-infarction period

Abstract

The aim – to identify markers of long-term cardiovascular risk in patients with acute myocardial infarction (AMI) with concomitant active COVID-19 and in patients with AMI during wartime, and to evaluate the impact of these factors on the course of the post-infarction period.
Materials and methods. A cohort of 160 patients with AMI was examined (mean age 64 years; 78 % men). The first group (n=80) was treated before the COVID-19 pandemic and served as a control group. The second group (n=31) was treated during the pandemic with active concomitant SARS-CoV-2 infection. The third group (n=49) was treated during wartime in Ukraine and had no active COVID-19 infection. All patients received standard in-hospital treatment according to current guidelines with appropriate clinical and laboratory evaluation. Patients who died during hospitalization were excluded. All enrolled patients underwent a 2-year follow-up. Outcomes included all-cause mortality, major cardiovascular events, and a composite endpoint of death or cardiovascular events.
Results and discussion. Patients with concomitant COVID-19 demonstrated a higher rate of long-term mortality (19.4  % vs 7.5 % in controls, p=0.1), whereas patients with AMI during wartime had the highest rate of nonfatal cardiovascular events (46.9 % vs 27.5 % in controls, p<0.05). Significant markers of long-term cardiovascular risk in AMI patients with COVID-19 included the lymphocyte percentage (> 15 % on day 1 of AMI and > 18 % on days 5–10), as well as a composite scale incorporating in-hospital lymphocyte percentages, total bilirubin, and HDL cholesterol measured on day 1 (sensitivity 91.7 %, specificity 87.5 %, p<0.001). In wartime AMI patients, long-term risk was predicted by a scale including leukocyte count, hemoglobin level and platelet inhomogeneity percentage by size on day 1, lymphocyte percentage and glucose level on days 5–10, as well as coronary stenting, in-hospital ticagrelor therapy, and the presence of > 2 significant (> 70 %) or > 3 total coronary stenoses (sensitivity 76.2 %, specificity 95 %, p<0.001).
Conclusions. In AMI patients, concomitant COVID-19 is associated with increased long-term mortality, while wartime factors increase long-term risk primarily through nonfatal cardiovascular events. These effects on the post-infarction period are linked to maladaptive inflammatory and stress responses to myocardial injury, reflected in specific clinical and laboratory changes. Unlike the previously widely used neutrophil-to-lymphocyte ratio, these markers allow individualized assessment of long-term cardiovascular risk in these patients.