Nationwide Analysis of the Impact of COVID-19 on ECMO Utilization in Patients Hospitalized with STEMI: A Retrospective Observational Study

Document Type

Abstract

Publication Date

4-1-2025

Abstract

Background: ST-segment-elevation myocardial infarction (STEMI) presents a healthcare burden in the United States. However, STEMI patients with COVID-19 have elevated in-hospital mortality. The use of extracorporeal membrane oxygenation (ECMO) for COVID-19 patients with STEMI is debated. We aimed to compare hospitalized STEMI patients with and without COVID-19, using a national database to understand the impact of concurrent COVID-19 infection on ECMO utilization rates. Methods: A retrospective cross-sectional observational study using Nationwide inpatient sample files between January and December 2020. COVID-19 population was identified and grouped into patients with STEMI and without-STEMI. Amongst STEMI patients, we used ICD-10 CM code to find out ECMO utilzation. SAS 9.4 was used for univariate (chi-square test and unpaired t-test) tests and mixed-effects survey logistic regression models to obtain odds ratio (OR) and 95%CI estimation for calculating odds of utilization and predictors of utilization, keeping p < 0.05 as significant. Results: We analysed 198,335 samples after excluding patients under 18 years and those with missing data for age, sex, and race. 6,455 cases had STEMI with COVID-19, while 191,880 were STEMI without COVID-19. STEMI patients with COVID-19 were more frequently female (21.55%), Hispanic (21.46%), or of African descent (14.72%). Furthermore, the incidence of STEMI associated with COVID-19 was found to be higher among individuals belonging to the Medicare beneficiary population (53.83%) and those with lesser incomes (0-25th percentile) (35.32%). Among patients with STEMI and COVID-19, the prevalence of ECMO utilization was higher (0.86% vs 0.07%, p < 0.0001). In regression analysis, STEMI patients with COVID-19 had 0.67 lower odds of ECMO utilization in compared to without COVID-19 (OR: 0.33, 95%CI: 0.25-0.44, p < 0.0001). Female (2.19, 1.18-4.08), African American (3.39, 1.63-7.03), patients with heart failure (4.97, 2.69-9.18), and arrythmias (2.79, 1.32-5.89) had higher ECMO utilization following STEMI. (Area under ROC/c value = 0.929) Conclusions: Though ECMO may improve survival rates for STEMI and refractory cardiogenic shock patients, especially patients with COVID-19 according to some studies, our research shows that STEMI patients with COVID-19 are less likely to receive ECMO. More prospective studies should be planned to evaluate the benefits of ECMO in severe COVID-19 infection. The above findings may help healthcare providers to improve the management to mitigate the burden of COVID-19 in STEMI patients.

Publication Title

Journal of Hospital Medicine

Volume

20

Issue

Supplement 1

First Page

S134

Last Page

S135

Link to Full Text

Open Access

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