Bu çalışma, Koronavirüs hastalığı-2019 (COVID-19) şüpheli veya kesin tanısı ile yatışı yapılan hastalarda kalp hızı değişkenliğinin (KHD) sağlıklı kontrollerle kıyaslanması ve proinflamatuvar sitokinler bağlamında değerlendirilmesi amacı ile tasarlandı. Gereç ve Yöntemler: Bu çalışmaya, 3 alt gruptan oluşan (53 kesin COVID-19 tanısı almış hasta, 42 şüpheli COVID-19 tanısı almış hasta ve 20 sağlıklı kontrol) toplam 115 denek dahil edildi. Hasta demografik özellikleri, inflamatuvar belirteçler (C-reaktif protein [CRP], D-Dimer, ferritin ve prokalsitonin) ve 24-saat Holter monitorizasyon parametrelerine ait veriler kaydedildi. Bulgular: Holter monitorizayonu parametrelerinin hiçbiri, şüpheli ve kesin COVID-19 tanısına sahip gruplar arasında anlamlı fark göstermedi. Şüpheli ve kesin COVID-19 tanılı her iki grupta, bütün NN intervallerinin standart sapması (SDNN, her biri için p<0,001) ve KHD triangular indeksi (her biri için p<0,001) değerleri kontrol grubu değerlerine göre anlamlı olarak daha düşük iken, ardışık normal NN intervalleri arasındaki farkların karekökü (RMSSD, her biri için p<0,001), düşük frekans (LF, sırasıyla p=0,001 ve p<0.001), yüksek frekans (HF, her biri için p<0,001) ve LF/HF oranı (her biri için p<0,001) değerleri kontrol grubu değerlerine göre anlamlı olarak daha yüksek bulundu. Prokalsitonin ve SDNN değerleri arasında pozitif korelasyon mevcuttu (r=0,227, p=0,044). Sonuç: Bulgularımız COVID-19 hastalarında KHD'nin hem zaman-bağımlı hem de frekans-bağımlı parametreler açısından önemli değişimler gösterdiğine ve bu değişimin viral yükten bağımsız olup, otonom sinir sistemi disfonksiyonu lehine olduğuna işaret etmektedir. Dolayısıyla bulgularımız, KHD'nin COVID-19 hastalarında altta yatan inflamatuvar sürece veya tedavi yan etkilerine bağlı gelişen otonom disfonksiyonun değerlendirilmesi açısından kullanışlı bir klinik araç olarak sitokin fırtınasının erken tahmini, tiraj, hastalık progresyonunun izlenmesi ve tedavi bakımından klinisyenlere yol gösterebileceği yönündedir.

ObjectiveThe initial data of the International Study on Acute Coronary Syndromes - ST Elevation Myocardial Infarction COVID-19 showed in Europe a remarkable reduction in primary percutaneous coronary intervention procedures and higher in-hospital mortality during the initial phase of the pandemic as compared with the prepandemic period. The aim of the current study was to provide the final results of the registry, subsequently extended outside Europe with a larger inclusion period (up to June 2020) and longer follow-up (up to 30 days).MethodsThis is a retrospective multicentre registry in 109 high-volume primary percutaneous coronary intervention (PPCI) centres from Europe, Latin America, South-East Asia and North Africa, enrolling 16 674 patients with ST segment elevation myocardial infarction (STEMI) undergoing PPPCI in March/June 2019 and 2020. The main study outcomes were the incidence of PPCI, delayed treatment (ischaemia time >12 hours and door-to-balloon >30 min), in-hospital and 30-day mortality.ResultsIn 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio 0.843, 95% CI 0.825 to 0.861, p<0.0001). This reduction was significantly associated with age, being higher in older adults (>75 years) (p=0.015), and was not related to the peak of cases or deaths due to COVID-19. The heterogeneity among centres was high (p<0.001). Furthermore, the pandemic was associated with a significant increase in door-to-balloon time (40 (25–70) min vs 40 (25–64) min, p=0.01) and total ischaemia time (225 (135–410) min vs 196 (120–355) min, p<0.001), which may have contributed to the higher in-hospital (6.5% vs 5.3%, p<0.001) and 30-day (8% vs 6.5%, p=0.001) mortality observed during the pandemic.ConclusionPercutaneous revascularisation for STEMI was significantly affected by the COVID-19 pandemic, with a 16% reduction in PPCI procedures, especially among older patients (about 20%), and longer delays to treatment, which may have contributed to the increased in-hospital and 30-day mortality during the pandemic.Trial registration numberNCT04412655.

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SARS-Cov-2 has been suggested to promote thrombotic complications and higher mortality. The aim of the present study was to evaluate the impact of SARS-CoV-2 positivity on in-hospital outcome and 30-day mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) enrolled in the International Survey on Acute Coronary Syndromes ST-segment elevation Myocardial Infarction (ISACS-STEMI COVID-19 registry. The 109 SARS-CoV-2 positive patients were compared with 2005 SARS-CoV-2 negative patients. Positive patients were older ( P = .002), less often active smokers ( P = .002), and hypercholesterolemic ( P = .006), they presented more often later than 12 h ( P = .037), more often to the hub and were more often in cardiogenic shock ( P = .02), or requiring rescue percutaneous coronary intervention after failed thrombolysis (P < .0001). Lower postprocedural Thrombolysis in Myocardial Infarction 3 flow ( P = .029) and more thrombectomy ( P = .046) were observed. SARS-CoV-2 was associated with a significantly higher in-hospital mortality (25.7 vs 7%, adjusted Odds Ratio (OR) [95% Confidence Interval] = 3.2 [1.71-5.99], P < .001) in-hospital definite in-stent thrombosis (6.4 vs 1.1%, adjusted Odds Ratio [95% CI] = 6.26 [2.41-16.25], P < .001) and 30-day mortality (34.4 vs 8.5%, adjusted Hazard Ratio [95% CI] = 2.16 [1.45-3.23], P < .001), confirming that SARS-CoV-2 positivity is associated with impaired reperfusion, with negative prognostic consequences.

Circumflex coronary artery anomalies are the most common type so far observed. However, a dual origin of the circumflex is an extremely rare anomaly. We describe two different patients admitted to our clinic with acute coronary syndrome at the same day. Angiography revealed twin circumflex arteries: one from the left main artery and the other from the proximal right coronary artery.

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Background: The constraints in the management of patients with ST-segment elevation myocardial infarction (STEMI) during the COVID-19 pandemic have been suggested to have severely impacted mortality levels. The aim of the current analysis is to evaluate the age-related effects of the COVID-19 pandemic on mechanical reperfusion and 30-day mortality for STEMI within the registry ISACS-STEMI COVID-19. Methods: This retrospective multicenter registry was performed in high-volume PPCI centers on four continents and included STEMI patients undergoing PPCI in March–June 2019 and 2020. Patients were divided according to age (< or ≥75 years). The main outcomes were the incidence and timing of PPCI, (ischemia time longer than 12 h and door-to-balloon longer than 30 min), and in-hospital or 30-day mortality. Results: We included 16,683 patients undergoing PPCI in 109 centers. In 2020, during the pandemic, there was a significant reduction in PPCI as compared to 2019 (IRR 0.843 (95%-CI: 0.825–0.861, p < 0.0001). We found a significant age-related reduction (7%, p = 0.015), with a larger effect on elderly than on younger patients. Furthermore, we observed significantly higher 30-day mortality during the pandemic period, especially among the elderly (13.6% vs. 17.9%, adjusted HR (95% CI) = 1.55 [1.24–1.93], p < 0.001) as compared to younger patients (4.8% vs. 5.7%; adjusted HR (95% CI) = 1.25 [1.05–1.49], p = 0.013), as a potential consequence of the significantly longer ischemia time observed during the pandemic. Conclusions: The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a 16% reduction in PPCI procedures, with a larger reduction and a longer delay to treatment among elderly patients, which may have contributed to increase in-hospital and 30-day mortality during the pandemic.

The so-called “smoking paradox”, conditioning lower mortality in smokers among STEMI patients, has seldom been addressed in the settings of modern primary PCI protocols. The ISACS–STEMI COVID-19 is a large-scale retrospective multicenter registry addressing in-hospital mortality, reperfusion, and 30-day mortality among primary PCI patients in the era of the COVID-19 pandemic. Among the 16,083 STEMI patients, 6819 (42.3%) patients were active smokers, 2099 (13.1%) previous smokers, and 7165 (44.6%) non-smokers. Despite the impaired preprocedural recanalization (p < 0.001), active smokers had a significantly better postprocedural TIMI flow compared with non-smokers (p < 0.001); this was confirmed after adjustment for all baseline and procedural confounders, and the propensity score. Active smokers had a significantly lower in-hospital (p < 0.001) and 30-day (p < 0.001) mortality compared with non-smokers and previous smokers; this was confirmed after adjustment for all baseline and procedural confounders, and the propensity score. In conclusion, in our population, active smoking was significantly associated with improved epicardial recanalization and lower in-hospital and 30-day mortality compared with previous and non-smoking history.