Incidence of recurrent adverse cardiovascular events among patients with acute myocardial infarction during the first wave of the COVID-19 pandemic in Bangladesh: a prospective observational study

Background and Aims: COVID-19 is an independent risk factor for cardiovascular disease. We investigated undiagnosed COVID-19 and its effect on recurrent adverse cardiovascular events among patients with acute myocardial infarction (AMI). Methods: We enrolled patients with either ST-segment elevation (STEMI) or non ST-segment elevation myocardial infarction (NSTEMI) presenting at the National Institute of Cardiovascular Disease, Dhaka, from June 28 to August 11, 2020. Nasopharyngeal swabs were collected for SARS-CoV-2 testing by rRT-PCR at enrolment. We followed all patients from admission until February 7, 2021, before the COVID-19 vaccination in Bangladesh, to register clinical endpoints (all-cause death, new AMI, heart failure, or new revascularization). Demographic information, cardiovascular risk factors, and clinical data were registered. Incidence rate (IR) per 100 person-years follow-up was calculated for clinical endpoints. Poisson regression was employed to estimate the incidence rate ratio (IRR) for SARS-COV-2 infection, adjusting for age. Results: We enrolled 280 patients with a mean age of 54.5 (± SD,11.8) years, and 78.6% were males. Of them, 12.9% had undiagnosed SARS-CoV-2 infection and were diagnosed with STEMI (n = 140, 50.0%) and NSTEMI (n = 140, 50.0%). We found that the IR per 100 person-years of all cause death was 35.2, 95% CI: 25.6 to 48.5; recurrent AMI was 18.5, 95% CI: 12.1 to 28.2; heart failure was 6.7, 95% CI: 3.3 to 13.5; and revascularization was 23.5, 95% CI: 16.1 to 34.3. Patients with COVID-19 had numerically higher IRRs for heart failure (2.40, 95% CI: 0.47 to 12.09, p = 0.290) and revascularization (1.11, 95% CI: 0.37 to 3.3, p = 0.853) compared to those without COVID-19, though these differences were not statistically significant. Conclusion: This study provides updated data on undiagnosed cases among AMI patients during the first wave of the COVID-19 pandemic. Our findings emphasize the need for further research to explore the impact of COVID-19 on AMI patients in resource-limited settings like Bangladesh.