COVID-19 pandemic and triggered acute myocardial infarction and out-of-hospital cardiac arrest in non-infected individuals

Background and Aims: The Covid-19 pandemic-related stressors are associated with behavioral and psychological problems, but no reports describe the pandemic stress triggering acute coronary events including acute myocardial infarction (AMI) and out-of-hospital cardiac arrest (OHCA) among individuals not infected with the covid-19 virus. Methods: We enrolled Covid-19 negative patients with AMI or OHCA admitted to 8 centers in Jordan during the covid-19 pandemic (March 15 through December 31, 2020). All of the patients were exposed to pandemic-related psychosocial and financial stressors. Results: We enrolled 177 patients (mean age 59.6+9.9 years, 84% men). Hypertension was present in 50%, diabetes in 45%, cigarette smoking in 71%, and 36% had history of cardiovascular disease (CVD). Of the whole group, 166 (94%) had AMI and 11 (6%) had OHCA. Patients with OHCA were younger (55.0+7.1 vs. 59.9+10.7 years, p<0.05) and had lower rate of past CVD (9% vs. 37%, p<0.001) compared with AMI patients. Of the AMI patients, 147 (83%) had coronary angiography, 119 (67%) had percutaneous angioplasty and 14 (8%) had bypass surgery. Survival rate was 0 for the OHCA patients and 98.2% for AMI patients (p<0.0001). The most common reported pandemic-related triggers the patients were exposed to included financial hardships in 82 (46%), loneliness in 77 (44%), fear to contract the virus or of lack of medical care in 55 (31%), anger in 29 (16%), and heavy physical exertion in 8 patients (5%). Conclusions: The Covid-19 pandemic-related stressors can potentially trigger life threatening acute coronary events. The minority of patients who had OHCA had a grim prognosis.