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Multicenter Study
. 2021 Sep:332:48-54.
doi: 10.1016/j.atherosclerosis.2021.06.926. Epub 2021 Jul 21.

Impact of SARS-CoV-2 positivity on clinical outcome among STEMI patients undergoing mechanical reperfusion: Insights from the ISACS STEMI COVID 19 registry

Giuseppe De Luca  1 , Niels Debel  2 , Miha Cercek  3 , Lisette Okkels Jensen  4 , Marija Vavlukis  5 , Lucian Calmac  6 , Tom Johnson  7 , Gerard Rourai Ferrer  8 , Vladimir Ganyukov  9 , Wojtek Wojakowski  10 , Tim Kinnaird  11 , Clemens von Birgelen  12 , Yves Cottin  13 , Alexander IJsselmuiden  14 , Bernardo Tuccillo  15 , Francesco Versaci  16 , Kees-Jan Royaards  17 , Jurrien Ten Berg  18 , Mika Laine  19 , Maurits Dirksen  20 , Massimo Siviglia  21 , Gianni Casella  22 , Petr Kala  23 , José Luis Díez Gil  24 , Adrian Banning  25 , Victor Becerra  26 , Ciro De Simone  27 , Andrea Santucci  28 , Xavier Carrillo  29 , Alessandra Scoccia  30 , Giovanni Amoroso  31 , Arnoud Wj Van't Hof  32 , Tomas Kovarnik  33 , Grigorios Tsigkas  34 , Julinda Mehilli  35 , Gabriele Gabrielli  36 , Xacobe Flores Rios  37 , Nikola Bakraceski  38 , Sébastien Levesque  39 , Giuseppe Cirrincione  40 , Vincenzo Guiducci  41 , Michał Kidawa  42 , Leonardo Spedicato  43 , Lucia Marinucci  44 , Peter Ludman  45 , Filippo Zilio  46 , Gennaro Galasso  47 , Enrico Fabris  48 , Maurizio Menichelli  49 , Arturo Garcia-Touchard  50 , Stephane Manzo  51 , Gianluca Caiazzo  52 , Jose Moreu  53 , Juan Sanchis Forés  54 , Luca Donazzan  55 , Luigi Vignali  56 , Rui Teles  57 , Edouard Benit  58 , Pierfrancesco Agostoni  59 , Francisco Bosa Ojeda  60 , Heidi Lehtola  61 , Santiago Camacho-Freiere  62 , Adriaan Kraaijeveld  63 , Ylitalo Antti  64 , Marco Boccalatte  65 , Pierre Deharo  66 , Iñigo Lozano Martínez-Luengas  67 , Bruno Scheller  68 , Efthymia Varytimiadi  69 , Raul Moreno  70 , Giuseppe Uccello  71 , Benjamin Faurie  72 , Alejandro Gutierrez Barrios  73 , Marek Milewski  74 , Ewout Bruwiere  58 , Pieter Smits  17 , Bor Wilbert  18 , Fortunato Scotto Di Uccio  15 , Guido Parodi  75 , Elvin Kedhi  76 , Monica Verdoia  77
Affiliations
Multicenter Study

Impact of SARS-CoV-2 positivity on clinical outcome among STEMI patients undergoing mechanical reperfusion: Insights from the ISACS STEMI COVID 19 registry

Giuseppe De Luca et al. Atherosclerosis. 2021 Sep.

Abstract

Background and aims: SARS-Cov-2 predisposes patients to thrombotic complications, due to excessive inflammation, endothelial dysfunction, platelet activation, and coagulation/fibrinolysis disturbances. The aim of the present study was to evaluate clinical characteristics and prognostic impact of SARS-CoV-2 positivity among STEMI patients undergoing primary percutaneous coronary intervention (PPCI).

Methods: We selected SARS-CoV-2 positive patients included in the ISACS-STEMI COVID-19, a retrospective multicenter European registry including 6609 STEMI patients treated with PPCI from March 1st until April 30th, in 2019 and 2020. As a reference group, we randomly sampled 5 SARS-Cov-2 negative patients per each SARS-CoV-2 positive patient, individually matched for age, sex, and hospital/geographic area. Study endpoints were in-hospital mortality, definite stent thrombosis, heart failure.

Results: Our population is represented by 62 positive SARS-CoV-2 positive patients who were compared with a matched population of 310 STEMI patients. No significant difference was observed in baseline characteristics or the modality of access to the PCI center. In the SARS-CoV-2 positive patients, the culprit lesion was more often located in the RCA (p < 0.001). Despite similar pre and postprocedural TIMI flow, we observed a trend in higher use of GP IIb-IIIa inhibitors and a significantly higher use of thrombectomy in the SARS-CoV-2 positive patients. SARS-CoV-2 positivity was associated with a remarkably higher in hospital mortality (29% vs 5.5%, p < 0.001), definite in-stent thrombosis (8.1% vs 1.6%, p = 0.004) and heart failure (22.6% vs 10.6%, p = 0.001) that was confirmed after adjustment for confounding factors.

Conclusions: Our study showed that among STEMI patients, SARS-CoV-2 positivity is associated with larger thrombus burden, a remarkably higher mortality but also higher rates of in-stent thrombosis and heart failure.

Trial registration: ClinicalTrials.gov NCT04412655.

Keywords: SARS-CoV-2; ST segment elevation myocardial infarction; Thrombosis(please add them).

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Image 1
Graphical abstract
Fig. 1
Fig. 1
Impact of SARS-Cov-2 positivity on in-hospital mortality (A). Outcome of patients according to SARS-Cov-2 positivity and use of thrombectomy (THR) suggesting potential benefits from thrombectomy especially among SARS-Cov-2 positive patients (B).
Fig. 2
Fig. 2
Impact of SARS-Cov-2 positivity on in-hospital definite stent thrombosis (A). Outcome of patients according to SARS-Cov-2 positivity and use of thrombectomy suggesting potential benefits from thrombectomy especially among SARS-Cov-2 positive patients (B).
See this image and copyright information in PMC

Comment in

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