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. 2021 Feb 15;97(3):E319-E326.
doi: 10.1002/ccd.29114. Epub 2020 Jul 15.

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

Batric Popovic  1 , Jeanne Varlot  1 , Pierre Adrien Metzdorf  1 , Hélène Jeulin  2 , François Goehringer  3 , Edoardo Camenzind  1
Affiliations

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

Batric Popovic et al. Catheter Cardiovasc Interv. .

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.

Keywords: Acute myocardial infarction/STEMI; Coronary Artery Disease; Percutaneous Coronary Intervention.

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Figures

FIGURE 1
FIGURE 1
The clinical course of a 38‐year‐old patient with acute respiratory distress syndrome due to SARS‐CoV‐2 infection was complicated by concomitant anterior ST‐elevation myocardial infarction and pulmonary embolism
FIGURE 2
FIGURE 2
Representative multivessel thrombotic MINOCA involving LAD and RCA in a 49‐year‐old patient with acute respiratory distress
See this image and copyright information in PMC

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