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Multicenter Study
. 2021 Sep;98(3):E370-E378.
doi: 10.1002/ccd.29709. Epub 2021 Apr 27.

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

Alexandre Abizaid  1   2   3 , Carlos M Campos  1   4 , Patrícia O Guimarães  1 , José de Ribamar Costa Jr  3   5 , Breno A A Falcão  6 , Fernanda Mangione  7 , Adriano Caixeta  8 , Pedro A Lemos  9 , Fabio S de Brito Jr  1   2   10 , Ricardo Cavalcante  10 , Cristiano Guedes Bezerra  11 , Leandro Cortes  12 , Henrique B Ribeiro  13 , Francis R de Souza  1 , Natassja Huemer  1 , Renata M do Val  1 , Bruno Caramelli  1 , Daniela Calderaro  1 , Felipe G Lima  1 , Ludhmila A Hajjar  1 , Roxana Mehran  14 , Roberto Kalil Filho  1   2 ; COVID MI investigators
Affiliations
Multicenter Study

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

Alexandre Abizaid et al. Catheter Cardiovasc Interv. 2021 Sep.

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.

Keywords: coronary angiography; coronavirus disease 2019; myocardial infarction.

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Conflict of interest statement

Dr. Mehran reports institutional research grants from Abbott Laboratories, Abiomed, Applied Therapeutics, AstraZeneca, Bayer, Beth Israel Deaconess, Bristol‐Myers Squibb, CERC, Chiesi, Concept Medical, CSL Behring, DSI, Medtronic, Novartis Pharmaceuticals, OrbusNeich; consultant fees from Abbott Laboratories, Boston Scientific, CardiaWave, Chiesi, Janssen Scientific Affairs, Medscape/WebMD, Medtelligence (Janssen Scientific Affairs), Roivant Sciences, Sanofi, Siemens Medical Solutions; consultant fees paid to the institution from Abbott Laboratories, Bristol‐Myers Squibb; advisory board, funding paid to the institution from Spectranetics/Philips/Volcano Corp; consultant (spouse) from Abiomed, The Medicines Company, Merck; Equity <1% from Claret Medical, Elixir Medical; DSMB Membership fees paid to the institution from Watermark Research Partners; consulting (no fee) from Idorsia Pharmaceuticals Ltd., Regeneron Pharmaceuticals; Associate Editor for ACC, AMA. Dr. Abizaid receives consulting fees from Boston Scientific. All other authors have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Survival curves according to clinical presentation and myocardial blush grades. NSTEMI, non‐ST‐segment elevation myocardial infarction; STEMI, ST‐segment elevation myocardial infarction
See this image and copyright information in PMC

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