tetano
Editor, Senior Moderator
J Clin Med
. 2022 Nov 4;11(21):6542.
doi: 10.3390/jcm11216542.
The Challenge of High Coronary Thrombotic Events in Patients with ST-Segment Elevation Myocardial Infarction and COVID-19
Larisa Anghel[SUP] 1 2 [/SUP], Bogdan-Sorin Tudurachi[SUP] 2 [/SUP], Andreea Leonte[SUP] 2 [/SUP], Radu Andy Sascău[SUP] 1 2 [/SUP], Ioana Mădălina Zota[SUP] 1 2 [/SUP], Amin Bazyani[SUP] 3 [/SUP], Grigore Tinică[SUP] 1 4 [/SUP], Cristian Stătescu[SUP] 1 2 [/SUP]
Affiliations
Abstract
The aim of this observational study was to describe the characteristics and outcomes of coronavirus disease 2019 (COVID-19)-positive patients with ST-segment elevation myocardial infarction (STEMI), with a special focus on factors associated with a high risk of coronary thrombosis and in-hospital mortality. Comparing the two groups of patients with STEMI separated according to the presence of SARS-CoV-2 infections, it was observed that COVID-19 patients were more likely to present with dyspnea (82.43% vs. 61.41%, p = 0.048) and cardiogenic shock (10.52% vs. 5.40%, p = 0.012). A longer total ischemia time was observed in COVID-19 patients, and they were twice as likely to undergo coronary angiography more than 12 hours after the onset of symptoms (19.29% vs. 10.13%, p = 0.024). In 10 of 57 COVID-19-positive patients, a primary PCI was not necessary, and only thromboaspiration was performed (17.54% vs. 2.70%, p < 0.001). Platelet level was inversely correlated (r = -0.512, p = 0.025) with a higher risk of coronary thrombosis without an atherosclerotic lesion. Using a cut-off value of 740 ng/ml, D-dimers predicted a higher risk of coronary thrombosis, with a sensitivity of 80% and a specificity of 66% (ROC area under the curve: 0.826, 95% CI: 0.716-0.935, p = 0.001). These are novel findings that raise the question of whether more aggressive antithrombotic therapy is necessary for selected COVID-19 and STEMI patients.
Keywords: COVID-19; SARS-CoV-2; STEMI; coronary disease; in-hospital mortality; thrombotic events.
. 2022 Nov 4;11(21):6542.
doi: 10.3390/jcm11216542.
The Challenge of High Coronary Thrombotic Events in Patients with ST-Segment Elevation Myocardial Infarction and COVID-19
Larisa Anghel[SUP] 1 2 [/SUP], Bogdan-Sorin Tudurachi[SUP] 2 [/SUP], Andreea Leonte[SUP] 2 [/SUP], Radu Andy Sascău[SUP] 1 2 [/SUP], Ioana Mădălina Zota[SUP] 1 2 [/SUP], Amin Bazyani[SUP] 3 [/SUP], Grigore Tinică[SUP] 1 4 [/SUP], Cristian Stătescu[SUP] 1 2 [/SUP]
Affiliations
- PMID: 36362770
- DOI: 10.3390/jcm11216542
Abstract
The aim of this observational study was to describe the characteristics and outcomes of coronavirus disease 2019 (COVID-19)-positive patients with ST-segment elevation myocardial infarction (STEMI), with a special focus on factors associated with a high risk of coronary thrombosis and in-hospital mortality. Comparing the two groups of patients with STEMI separated according to the presence of SARS-CoV-2 infections, it was observed that COVID-19 patients were more likely to present with dyspnea (82.43% vs. 61.41%, p = 0.048) and cardiogenic shock (10.52% vs. 5.40%, p = 0.012). A longer total ischemia time was observed in COVID-19 patients, and they were twice as likely to undergo coronary angiography more than 12 hours after the onset of symptoms (19.29% vs. 10.13%, p = 0.024). In 10 of 57 COVID-19-positive patients, a primary PCI was not necessary, and only thromboaspiration was performed (17.54% vs. 2.70%, p < 0.001). Platelet level was inversely correlated (r = -0.512, p = 0.025) with a higher risk of coronary thrombosis without an atherosclerotic lesion. Using a cut-off value of 740 ng/ml, D-dimers predicted a higher risk of coronary thrombosis, with a sensitivity of 80% and a specificity of 66% (ROC area under the curve: 0.826, 95% CI: 0.716-0.935, p = 0.001). These are novel findings that raise the question of whether more aggressive antithrombotic therapy is necessary for selected COVID-19 and STEMI patients.
Keywords: COVID-19; SARS-CoV-2; STEMI; coronary disease; in-hospital mortality; thrombotic events.