Acute coronary syndromes in the era of SARS-CoV-2 Infection: A registry of the French group of acute cardiac care

Background Cardiovascular complications are frequent in SARS-CoV-2 patients. The characteristics of acute coronary syndromes (ACS) in this population have not yet been reported. Purpose We aimed to report clinical characteristics and outcome of patients with and without SARS-CoV-2 infection referred for acute coronary syndrome (ACS) during the peak of the pandemic in France. Methods We included all consecutive patients referred for ST-elevation myocardial infarction (STEMI) or NSTEMI during the first 3 weeks of April 2020 in 5 university hospitals (Paris, south and north of France), all performing primary percutaneous coronary intervention (PCI). Results The study included 237 patients (67 ± 14, 69% of male), 111 (49%) with STEMI and 121 (51%) with NSTEMI. The prevalence of SARS-CoV-2 associated ACS was 11% (n = 26) and 11 patients had severe hypoxemia on presentation (mechanical ventilation or nasal oxygen >6L/min). Patients were comparable regarding medical history and risk factors, except higher prevalence of diabetes mellitus in SARS-CoV-2 patients (53.8% vs. 25.5%, P = 0.003). In SARS-CoV-2 patients, admission for cardiac arrest was more frequent (26.9% vs. 6.6%, P < 0.001), and significant coronary artery disease and culprit artery occlusion were reported in 76.5% and 92% of STEMI patients, and 88.9% and 50% of NSTEMI, respectively. PCI was performed in the same percentage of STEMI (82%) and NSTEMI (86%) cases, regardless of SARS-CoV-2 infection, but no-reflow after PCI (19.2% vs. 3.3%, P < 0.001) was greater in SARS-CoV-2 patients. In-hospital death occurred in 7 SARS-CoV-2 patients (5 from cardiac cause) and was higher compared to non-infected patients (26.9% vs. 6.2%, P < 0.001) Conclusion SARS-CoV-2 infection is frequent in ACS patients with higher incidence of coronary occlusion and no-reflow compared to non-SARS-CoV-2 ACS, which may explain the higher in-hospital mortality, despite a similar rate of PCI.

[SARS-COV-2 myocarditis. An update]. / Myocardite et maladie à COVID-19 : où en est-on ?

The outbreak of the SARS-CoV-2 virus responsible for the COVID-19 disease has given rise to a new disease whose boundaries are still to be discovered. While the first data suggested a purely respiratory infection, the most recent publications highlight a large pleomorphism of the disease, responsible for multiple organ damage, of which cardiac injury seems to be the most represented. This cardiac injury can present as acute myocarditis. Our aim was to discuss the pathophysiological rationale underlying the existence of SARS-CoV-2 myocarditis and to analyze the literature data regarding the diagnosis and treatment of this particular entity.