Patients with COVID‐19 who experience a myocardial infarction have complex coronary morphology and high in‐hospital mortality: Primary results of a nationwide angiographic study

Abstract

Objectives We aimed to explore angiographic patterns and in‐hospital outcomes of patients with concomitant coronavirus disease‐19 (COVID‐19) and myocardial infarction (MI). Background Patients with COVID‐19 may experience MI during the course of the viral infection. However, this association is currently poorly understood. Methods This is a multicenter prospective study of consecutive patients with concomitant COVID‐19 and MI who underwent coronary angiography. Quantitative and qualitative coronary angiography were analyzed by two observers in an independent core lab. Results A total of 152 patients were included, of whom 142 (93.4%) had COVID‐19 diagnosis confirmation. The median time between symptom onset and hospital admission was 5 (1–10) days. A total of 83 (54.6%) patients presented with ST‐elevation MI. The median angiographic Syntax score was 16 (9.0–25.3) and 69.0% had multi‐vessel disease. At least one complex lesion was found in 73.0% of patients, 51.3% had a thrombus containing lesion, and 57.9% had myocardial blush grades 0/1. The overall in‐hospital mortality was 23.7%. ST‐segment elevation MI presentation and baseline myocardial blush grades 0 or 1 were independently associated with a higher risk of death (HR 2.75, 95%CI 1.30–5.80 and HR 3.73, 95%CI 1.61–8.61, respectively). Conclusions Patients who have a MI in the context of ongoing COVID‐19 mostly present complex coronary morphologies, implying a background of prior atherosclerotic disease superimposed on a thrombotic milieu. The in‐hospital prognosis is poor with a markedly high mortality, prompting further investigation to better clarify this newly described condition.

Cumulative Evidence for the Association of Thrombosis and the Prognosis of COVID-19: Systematic Review and Meta-Analysis

“…Five studies ( 25 , 38 , 42 , 51 , 55 ) were conducted in the United States, 5 studies ( 24 , 26 , 39 , 46 , 54 ) were conducted in Asia, 14 studies ( 7 , 27 , 28 , 37 , 40 , 41 , 43 , 44 , 47 – 50 , 52 , 53 ) were conducted in Europe, and one study ( 45 ) was conducted in Brazil. All the included studies included both adult men and women.…”

“…Among the included studies, 13 studies ( 25 – 27 , 39 , 42 , 45 , 46 , 48 – 50 , 52 , 53 , 55 ) adjusted for age, 7 studies ( 27 , 39 , 48 , 49 , 52 , 53 , 55 ) adjusted for sex, one study ( 42 ) adjusted for BMI, 8 studies ( 26 , 39 , 47 , 49 , 50 , 52 , 53 , 55 ) adjusted for diabetes mellitus, and 7 studies ( 39 , 43 , 46 , 47 , 49 , 52 , 55 ) adjusted for 8 or more confounding factors.…”

“…Among the 25 selected studies, 19 studies revealed the association between thrombosis and COVID-19-related mortality, and 10 studies investigated the association between thrombosis and COVID-19-related critical status. Among the included studies, 5 studies ( 26 , 43 , 47 , 48 , 51 ) found a non-significant association between thrombosis and COVID-19-related mortality, while the other 14 studies ( 24 , 25 , 27 , 28 , 39 , 40 , 42 , 45 , 46 , 49 , 50 , 52 , 53 , 55 ) revealed that thrombosis would increase the risk of mortality from COVID-19. All 19 studies reported risks as ORs, ranging from 0.79 to 40.27.…”

Treatment Delay and Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction during the COVID-19 Pandemic

“…Furthermore, pandemic-specific protocols require additional time to prepare medical staff and the catheterization laboratory before the procedure [1][2][3][4]. Thus, patients with STEMI might be exposed to longer delays for angiography with revascularization and increased risk of death [4,[8][9][10][11][12]. Furthermore, some data suggest additional treatment delay for PCIs performed during off-hours [13,14].…”

“…These agents might be linked with a higher rate of bleeding and vascular complications [5,6]. However, current reports emphasize hypercoagulability and high thrombus burden with potentially detrimental outcomes in patients with STEMI and COVID-19 diagnosis [8][9][10][11][12]. Irrespective of the exponential growth of evidence, there are still limited data on the clinical outcomes in STEMI with diagnosed COVID-19.…”