Myocardial Infarction in Children after COVID-19 and Risk Factors for Thrombosis

Abstract

Acute myocardial infarction (AMI) in children is rather anecdotic. However, following COVID-19, some conditions may develop which may favor thrombosis, myocardial infarction, and death. Such a condition is Kawasaki-like disease (K-lD). K-lD appears in children as a subgroup of the multisystem inflammatory syndrome (MIS-C). In some cases, K-lD patients may develop giant coronary aneurysms. The evolution and characteristics of coronary aneurysms from K-lD appear to be different from classical Kawasaki disease (KD) aneurysms. Differences include a lower percentage of aneurysm formation than in non-COVID-19 KD, a smaller number of giant forms, a tendency towards aneurysm regression, and fewer thrombotic events associated with AMI. We present here a review of the literature on the thrombotic risks of post-COVID-19 coronary aneurysms, starting from a unique clinical case of a 2-year-old boy who developed multiple coronary aneurysms, followed by AMI. In dehydration conditions, 6 months after COVID-19, the boy developed anterior descending artery occlusion and a slow favorable outcome of the AMI after thrombolysis. This review establishes severity criteria and risk factors that predispose to thrombosis and AMI in post-COVID-19 patients. These may include dehydration, thrombophilia, congenital malformations, chronic inflammatory conditions, chronic kidney impairment, acute cardiac failure, and others. All these possible complications should be monitored during acute illness. Ischemic heart disease prevalence in children may increase in the post-COVID-19 era, due to an association between coronary aneurysm formation, thrombophilia, and other risk factors whose presence will make a difference in long-term prognosis.

Thrombotic Events in MIS-C Patients: A Single Case Report and Literature Review

“…We retrospectively reviewed the clinical history of 60 MIS-C patients who experienced TEs (37 studies) and we collected epidemiological, clinical, laboratory, and treatment data ( Table 1 ) [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ].…”

“…Arterial thrombosis was involved the central nervous system in 25 patients (41.7%), pulmonary arteries in 8 (13.3%), and coronary arteries in 6 (10%). Renal arteries were affected in four patients (6.7%), whereas thrombosis of carotid arteries, peripheric systemic arteries, and the aorta were reported in two patients (3.3%) [ 10 , 11 , 12 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 22 , 24 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 35 , 36 , 37 , 38 , 40 , 41 , 42 , 43 , 44 , 45 , 47 ]. Venous thrombosis affected the deep veins of the lower and upper limbs in six (10%) and five (8.3%) of patients, respectively [ 10 , 15 , 21 , 27 , 43 ].…”

“…Thromboprophylaxis was administered to 24 patients (40%) [ 10 , 19 , 24 , 26 , 27 , 28 , 31 , 32 , 33 , 40 , 41 , 43 , 46 , 49 ]. One-third of them received low-dose heparin, and in four patients (6.7%), heparin along with antiplatelet aggregation was used.…”

Should We Be Screening for Ischaemic Heart Disease Earlier in Childhood?

“…The features of coronary aneurysms in MIS-C appear to be different compared with classic KD aneurysms. The most important differences are a lower likelihood of aneurysm formation than in classic KD, a reduced number of giant forms, a tendency towards aneurysm regression and less thrombotic events [ 56 ]. The long-term prognosis of this new form of coronary artery disease in children is still unknown, due to its too recent presentation.…”

Pathology of coronary arteries in children and its clinical significance

“…Ще одна причина розвитку ішемічної хвороби серця, що актуальна сьогодніасоційований із інфекцією COVID-19 мультисистемний запальний синдром у дітей (MIS-C). Подібно до ХК, MIS-C також може спричинити ураження серця з розвитком шоку, дисфункцією міокарда, змінами на ЕКГ та розвитком коронарних аневризм, що виявляються, за існуючими на сьогодні даними, приблизно в 15% дітей із MIS-C [4]. Коронарні аневризми при MIS-C відрізняються від класичних аневризм при ХК тим, що ймовірність їх виникнення нижча, менша схильність до розвитку гігантських аневризм, вони частіше регресують та спостерігається менша кількість тромботичних подій [4].…”