CHARACTERISTICS OF ACUTE MYOCARDIAL INFARCTION IN PATIENTS WITH IMPAIRED CARBOHYDRATE METABOLISM AND ATRIAL FIBRILLATION DURING A PANDEMIC CORONAVIRUS INFECTION

Maltsev A I, Koriagina N A, Koriagin V S

Relevance. The 2019 coronavirus disease pandemic (NCVI) affected more than 20 million people in Russia. Atrial fibrillation (AF) is associated with poor prognosis and increased mortality in patients with acute myocardial infarction (MI). AF patients with diabetes had significantly higher rates of hospitalization, cardiovascular mortality, and overall mortality, as well as more severe symptoms and poorer quality of life compared with AF patients without diabetes. We hypothesized that the COVID-19 pandemic would have a significant impact on the prognosis of MI patients with carbohydrate metabolism disorders and atrial fibrillation. The aim of the study was to analyze the differences in clinical, laboratory and clinical parameters between groups of patients who underwent MI, while having AF and carbohydrate metabolism disorders (CMD), in the period before and during the coronavirus pandemic. Materials and methods. The work included 441 patients who had myocardial infarction in the regional vascular center of the Clinical Cardiology Dispensary. From the recruited base of 441 people, comorbid patients were selected who had both CMD and AF. After the subanalysis, 2 groups were formed, according to the year of hospitalization. Statistical analysis was carried out using SPSS. Results. In the baseline groups, 151 patients were enrolled for the 2020 period and 290 patients for the 2019 period. A sub-analysis aimed at identifying comorbid patients with the combined presence of CUA and AF led to the following division: Group 1: patients admitted to hospital in 2019 with a diagnosis of MI in combination with AF and CFM (n=32), which was 11.5 % of the original sample of the given year. Group 2: Patients admitted to hospital in 2020 (n=34), representing 24.1% of that year's original sample. Statistical significance was found in the differences in the incidence of comorbid patients according to the years of the sample (p=0.001). These results may point to important trends in the distribution of comorbid conditions at different periods, and will require further study of these patient groups. The GRACE level in the 2019 group was 134.38 ± 35.94 compared to 144.91 ± 39.26 in the 2020 group (p=0.005). The proportion of Q-positive infarction in the 2019 group was 63.2%, while in 2020 it was 73.5% (p=0.032). Troponin values 0.200 (0.038 – 1.312) in 2019 vs. 0.698 (0.047 – 3.370) in 2020, p= 0.027. The creatine kinase-MB level in the 2020 group was significantly higher (p=0.004). Conclusions. Patients with AF and CMD hospitalized in 2020 were characterized by a more severe course of MI. The area and depth of myocardial damage in such patients was significantly lower than in patients before the pandemic. In addition, the number of comorbid patients with MI, AF, and CVR during hospitalization was twice as high during the NCVI pandemic. It is possible that changes in clinical protocols or the availability of medical services in 2020 could influence these indicators. Also, most of the patients underwent NKVI, which has a pronounced tropism for the tissues of the myocardium, pancreas and blood vessels. The NCVI pandemic may also have affected the ability of hospitals to respond to cardiac events due to the strain on the healthcare system.

Keywords:covid; Atrial fibrillation; Diabetes; SARS-CoV-2; myocardial infarction