tetano
Editor, Senior Moderator
J Am Coll Cardiol
. 2020 Jul 10;S0735-1097(20)35966-0.
doi: 10.1016/j.jacc.2020.07.022. Online ahead of print.
High Thrombus Burden in Patients with COVID-19 Presenting with ST-Elevation Myocardial Infarction
Fizzah A Choudry[SUP] 1 [/SUP], Stephen M Hamshere[SUP] 1 [/SUP], Krishnaraj S Rathod[SUP] 1 [/SUP], Mohammad M Akhtar[SUP] 1 [/SUP], R Andrew Archbold[SUP] 2 [/SUP], Oliver P Guttmann[SUP] 1 [/SUP], Simon Woldman[SUP] 1 [/SUP], Ajay K Jain[SUP] 1 [/SUP], Charles J Knight[SUP] 1 [/SUP], Andreas Baumbach[SUP] 1 [/SUP], Anthony Mathur[SUP] 1 [/SUP], Daniel A Jones[SUP] 3 [/SUP]
Affiliations
Abstract
Background: Coronavirus disease 2019 (COVID-19) is thought to predispose patients to thrombotic disease. To date there are few reports of ST-elevation myocardial infarction (STEMI) caused by type 1 myocardial infarction in COVID-19 patients.
Objectives: The aim of this study was to describe the demographic, angiographic, and procedural characteristics alongside clinical outcomes of consecutive cases of COVID-19 positive STEMI patients compared to COVID-19 negative patients.
Methods: This was a single-centre, observational study of 115 consecutive patients admitted with confirmed STEMI treated with primary percutaneous coronary intervention at Barts Heart Centre between 01/03/2020 and 20/05/2020.
Results: STEMI patients presenting with concurrent COVID-19 infection had higher levels of Troponin T, lower lymphocyte count, but elevated D-dimer and C-reactive protein. There was significantly higher rates of multi-vessel thrombosis, stent thrombosis, higher modified thrombus grade post first device with consequently higher use of GP IIb/IIIa inhibitors and thrombus aspiration. Myocardial blush grade and left ventricular function were significantly lower in COVID patients with STEMI. Higher doses of heparin to achieve therapeutic ACTs were also noted. Importantly, STEMI patients presenting with COVID-19 infection had a longer in-patient admission and higher rates of intensive care admission.
Conclusions: In patients presenting with STEMI and concurrent COVID-19 infection there is a strong signal towards higher thrombus burden and poorer outcomes. This supports the need for establishing COVID status in all STEMI cases. Further work is required to understand the mechanism of increased thrombosis and the benefit of aggressive anti-thrombotic therapy in selected cases.
Keywords: COVID-19; ST elevation myocardial infarction; primary percutaneous coronary intervention; thrombosis.
. 2020 Jul 10;S0735-1097(20)35966-0.
doi: 10.1016/j.jacc.2020.07.022. Online ahead of print.
High Thrombus Burden in Patients with COVID-19 Presenting with ST-Elevation Myocardial Infarction
Fizzah A Choudry[SUP] 1 [/SUP], Stephen M Hamshere[SUP] 1 [/SUP], Krishnaraj S Rathod[SUP] 1 [/SUP], Mohammad M Akhtar[SUP] 1 [/SUP], R Andrew Archbold[SUP] 2 [/SUP], Oliver P Guttmann[SUP] 1 [/SUP], Simon Woldman[SUP] 1 [/SUP], Ajay K Jain[SUP] 1 [/SUP], Charles J Knight[SUP] 1 [/SUP], Andreas Baumbach[SUP] 1 [/SUP], Anthony Mathur[SUP] 1 [/SUP], Daniel A Jones[SUP] 3 [/SUP]
Affiliations
- PMID: 32679155
- DOI: 10.1016/j.jacc.2020.07.022
Abstract
Background: Coronavirus disease 2019 (COVID-19) is thought to predispose patients to thrombotic disease. To date there are few reports of ST-elevation myocardial infarction (STEMI) caused by type 1 myocardial infarction in COVID-19 patients.
Objectives: The aim of this study was to describe the demographic, angiographic, and procedural characteristics alongside clinical outcomes of consecutive cases of COVID-19 positive STEMI patients compared to COVID-19 negative patients.
Methods: This was a single-centre, observational study of 115 consecutive patients admitted with confirmed STEMI treated with primary percutaneous coronary intervention at Barts Heart Centre between 01/03/2020 and 20/05/2020.
Results: STEMI patients presenting with concurrent COVID-19 infection had higher levels of Troponin T, lower lymphocyte count, but elevated D-dimer and C-reactive protein. There was significantly higher rates of multi-vessel thrombosis, stent thrombosis, higher modified thrombus grade post first device with consequently higher use of GP IIb/IIIa inhibitors and thrombus aspiration. Myocardial blush grade and left ventricular function were significantly lower in COVID patients with STEMI. Higher doses of heparin to achieve therapeutic ACTs were also noted. Importantly, STEMI patients presenting with COVID-19 infection had a longer in-patient admission and higher rates of intensive care admission.
Conclusions: In patients presenting with STEMI and concurrent COVID-19 infection there is a strong signal towards higher thrombus burden and poorer outcomes. This supports the need for establishing COVID status in all STEMI cases. Further work is required to understand the mechanism of increased thrombosis and the benefit of aggressive anti-thrombotic therapy in selected cases.
Keywords: COVID-19; ST elevation myocardial infarction; primary percutaneous coronary intervention; thrombosis.