Changes in characteristics and management among patients with ST‐elevation myocardial infarction due to COVID‐19 infection

Abstract

Objectives To assess changes in characteristics and management among ST‐elevation myocardial infarction (STEMI) patients with coronavirus disease (COVID‐19) who underwent primary percutaneous coronary intervention. Methods Our prospective, monocentric study enrolled all STEMI patients who underwent PPCI during the COVID‐19 outbreak ( n = 83). This cohort was first compared with a previous cohort of STEMI patients (2008–2017, n = 1,552 patients) and was then dichotomized into a non‐COVID‐19 group ( n = 72) and COVID‐19 group ( n = 11). Results In comparison with the pre‐outbreak period, patients during the outbreak period were older (59.6 ± 12.9 vs. 62.6 ± 12.2, p = .03) with a delayed seek to care (mean delay first symptoms‐balloon 3.8 ± 3 vs. .7.4 ± 7.7, p < .001) resulting in a two‐fold higher in‐hospital mortality (non COVID‐19 4.3% vs. COVID‐19 8.4%, p = .07). Among the 83 STEMI patients admitted during the outbreak period, 11 patients were infected by COVID‐19. Higher biological markers of inflammation (C‐reactive protein: 28 ± 39 vs. 98 ± 97 mg/L, p = .04), of fibrinolysis (D‐dimer: 804 ± 1,500 vs. 3,128 ± 2,458 μg/L, p = .02), and antiphospholipid antibodies in four cases were observed in the COVID‐19 group. In this group, angiographic data also differed: a thrombotic myocardial infarction nonatherosclerotic coronary occlusion (MINOCA) was observed in 11 cases (1.4% vs. 54.5%, p < .001) and associated with higher post‐procedure distal embolization (30.6% vs. 72.7%, p = .007). The in hospital mortality was significantly higher in the COVID‐19 group (5.6% vs. 27.3%, p = .016). Conclusion The COVID‐19 outbreak implies deep changes in the etiopathogenesis and therapeutic management of STEMI patients with COVID‐19. The impact on early and long‐term outcomes of systemic inflammation and hypercoagulability in this specific population is warranted.

Initial Findings From the North American COVID-19 Myocardial Infarction Registry

“…Furthermore, these patients more frequently have no culprit lesion on angiography and therefore are not expected to benefit from pharmacological reperfusion while being exposed to potentially harmful side effects associated with thrombolysis. The prognosis of STEMI patients with COVID-19 infection is highly variable, with reported in-patient mortality ranging from 12% to 72% ( 7 , 8 , 9 , 10 , 11 , 12 ).…”

COVID 19 pandemic: Its impact on cardiovascular training and care

“…Longer symptom-to-door-times has been demonstrated in patients with STEMI. 44 , 45 , 46 , 47 , 48 Some of the developed countries, did not observe any difference in door-to-balloon times pre-versus during-COVID-19. 47 , 48 However this should be taken as pinch of salt specially in developing countries where in COVID-19 era the delay is bound to occur.…”

A Rare Cause of ST-Segment Elevation Myocardial Infarction in COVID-19: MINOCA Syndrome

“…Although it is thought that many mechanisms such as hyperinflammation, cytokine storm, thrombosis, and hypoxia may occur together in the cardiac involvement of COVID-19, the increased thrombotic environment may induce MINOCA in COVID-19 patients with acute coronary syndrome 11 . In a prospective study compar-ing two different cohorts with and without COVID-19 in STEMI patients, coronary angiography was found to be compatible with MINOCA in 54% of patients in the COVID-19 group 12 . In our patient, whose coronary angiography did not have significant stenosis and CTPA could not reveal any evidence of pulmonary embolism, it was thought that the reason of typical anginal pain with ST-segment elevation in the inferior leads on the ECG was MINOCA triggered by hyperinflammation and thrombotic processes due to COVID-19.…”