Prognostic Impact of COVID-19 on Patients With Acute Coronary Syndrome Undergoing Emergent Percutaneous Coronary Intervention ― Insights From the J-PCI Nationwide Registry ―

BACKGROUND: Although the COVID-19 pandemic has impacted the management of acute coronary syndrome (ACS), the prognostic implications for ACS patients with concurrent COVID-19 undergoing percutaneous coronary intervention (PCI) remain to be determined, particularly in large nationwide cohorts. This study investigated the association between concomitant COVID-19 and clinical outcomes in patients undergoing emergent PCI for ACS. METHODS AND RESULTS: This retrospective cohort study utilized data from the Japanese Percutaneous Coronary Intervention (J-PCI) nationwide registry, encompassing all patients presenting with ACS who underwent primary or emergent PCI between January 2021 and December 2023. Multivariable logistic regression models were employed to ascertain the independent association between COVID-19 positivity and in-hospital all-cause and cardiovascular mortality. The analysis included 279,662 ACS patients, of whom 1,812 (0.65%) tested positive for COVID-19. After multivariable adjustment, COVID-19 remained an independent predictor of in-hospital all-cause mortality (adjusted odds ratio [aOR] 1.46; 95% confidence interval [CI] 1.21-1.77). The association between COVID-19 and cardiovascular mortality was significant in univariable analysis but not after multivariable adjustment (aOR 1.22; 95% CI 0.98-1.52). CONCLUSIONS: In this nationwide cohort, concomitant COVID-19 was independently associated with higher in-hospital all-cause mortality among patients with ACS undergoing PCI. These findings highlight the need for heightened surveillance and consideration of tailored therapeutic strategies in this high-risk population.