In-hospital outcomes of ST elevation myocardial infarction in post-COVID-19 patients.

Aim. To study clinical and anamnestic data, as well as inhospital outcomes in patients with ST elevation myocardial infarction (STEMI) with prior coronavirus disease 2019 (COVID-19) compared with previously uninfected STEMI patients. Material and methods. This prospective study included 181 patients treated for STEMI. The patients were divided into 2 groups, depending on the anti-SARS-CoV-2 IgG titer as follows: the main group included 62 seropositive patients, while the control group - 119 seronegative patients without prior COVID-19. Anamnesis, clinical and paraclinical examination, including electrocardiography, echocardiography, coronary angiography, were performed. Mortality and incidence of STEMI complications at the hospital stage were analyzed. Results. The mean age of the patients was 62,6+/-12,3 years. The vast majority were men (69,1% (n=125)). The median time from the onset of COVID-19 manifestations to STEMI was 60,00 [45,00;83,00] days. According to, the patients of both groups were comparable the severity of circulatory failure (p>0,05). Coronary angiography found that in patients of the main group, Thrombolysis In Myocardial Infarction (TIMI) score of 0-1 in the infarct-related artery was recorded much less frequently (62,9% (n=39) vs, 77,3% (n=92), p=0,0397). Patients of the main group demonstrated a lower concentration of leukocytes (9,30*109/l [7,80;11,40] vs 10,70*109/l [8,40;14,00], p=0,0065), higher levels of C-reactive protein (21,5 mg/L [9,1;55,8] vs 10,2 mg/L [5,1;20,5], p=0,0002) and troponin I (9,6 ng/mL [2,2;26,0] vs 7,6 ng/mL [2,2;11,5], p=0,0486). Lethal outcome was recorded in 6,5% (n=4) of cases in the main group and 8,4% (n=10) in the control group (p=0,6409). Both groups were comparable in terms of the incidence of complications (recurrent myocardial infarction, ventricular fibrillation, complete atrioventricular block, stroke, gastrointestinal bleeding) during hospitalization (p>0,05). Conclusion. Patients with STEMI after COVID-19, despite a more burdened history and higher levels of C-reactive protein and troponin I, compared with STEMI patients without COVID-19, did not differ significantly in clinical status, morbidity, and inhospital mortality.Copyright © 2023, Silicea-Poligraf. All rights reserved.

[Features of the course of non-ST elevation myocardial infarction in patients with a history of COVID-19].

Aim      To study the clinical course of non-ST segment elevation myocardial infarction (NSTEMI) in hospitalized patients after COVID-19 and to evaluate the effect of baseline characteristics of patients on the risk of complications.Material and methods  The study included 209 patients with NSTEMI; 104 of them had had COVID-19. The course of myocardial infarction (MI) was analyzed at the hospital stage, including evaluation of the incidence rate of complications (fatal outcome, recurrent MI, life-threatening arrhythmias and conduction disorders, pulmonary edema, cardiogenic shock, ischemic stroke, gastrointestinal bleeding).Results Mean age of patients after COVID-19 was 61.8±12.2 years vs. 69.0±13.0 in the comparison group (p<0.0001). The groups were comparable by risk factors, clinical data, and severity of coronary damage. Among those who have had СOVID-19, there were fewer patients of the GRACE high risk group (55.8 % vs. 74.3 %; p<0.05). Convalescent COVID-19 patients had higher levels of C-reactive protein and troponin I (p<0.05). The groups did not significantly differ in the incidence of unfavorable NSTEMI course (p>0.05). However, effects of individual factors (postinfarction cardiosclerosis, atrial fibrillation, decreased SpO2, red blood cell concentration, increased plasma glucose) on the risk of complications were significantly greater for patients after COVID-19 than for the control group (p<0.05).Conclusion      Patients with NSTEMI, despite differences in clinical history and laboratory data, are characterized by a similar risk of death at the hospital stage, regardless of the past COVID-19. Despite the absence of statistically significant differences in the incidence of in-hospital complications, in general, post-COVID-19 patients showed a higher risk of complicated course of NSTEMI compared to patients who had not have COVID-19. In addition, for this category of patients, new factors were identified that previously did not exert a clinically significant effect on the incidence of complications: female gender, concentration of IgG to SARS-CoV-2 ≥200.0 U/l, concentration of С-reactive protein ≥40.0 mg/l, total protein <65 g/l. These results can be used for additional stratification of risk for cardiovascular complications in patients with MI and also for development of individual protocols for evaluation and management of NSTEMI patients with a history of COVID-19.

Comparative assessment of efficacy and immunogenicity of Gam-COVID-Vac and CoviVac vaccines against SARS-CoV-2

The medical community is interested in the duration of immune protection and the level of specific antibodies (AB) that can pre-vent reinfection with SARS-CoV-2. Objective. To perform a comparative evaluation of efficacy and immunogenicity of Gam-COVID-Vac and CoviVac vaccines against SARS-CoV-2 in a prospective observational study. Material and methods. The following vaccines were used for the vaccination of subjects (n=3322) aged 18 years and older: Gam-COVID-Vac - 1,622 (48.8%) subjects (group I), CoviVac - 1,700 (51.2%) subjects (group II). Vaccinated subjects were fol-lowed up for 6 study visits: before the 1st component of the vaccine, before the 2nd component of the vaccine, 42 days, 3 months, 6 months, and 12 months after the 1st component of the vaccine. Immunoglobulin G (IgG) levels of AB to S protein were compared after the injection of Gam-COVID-Vac and CoviVac vaccines using an enzyme immunoassay. Statistical processing of the obtained data was performed using IBM SPSS Statistics v. 24 and MedCalc v. 20.104 software. Results. Group I subjects showed an increase in specific AB (IgG) levels to SARS-CoV-2 S protein from visit 1 to visits 2 and 3 (p<0.05). In more extended follow-up periods (visits 5, 6), AB levels in groups I and II did not differ significantly and remained sufficiently high by visit 6. Within one year of follow-up, the incidence of COVID-19 (confirmed by polymerase chain reaction) was significantly (p<0.01) lower in the Gam-COVID-Vac group (group I): 22.2% vs. 45.2% in the CoviVac group (group II). The maximum number of days (p<0.05) before the COVID-19 infection was observed in those vaccinated with Gam-COVID-Vac (221 days) compared to those immunized with CoviVac (159 days). Conclusion. The Gam-COVID-Vac vaccine is more effective against COVID-19 and induces a more rapid response of the hu-moral immune system than the CoviVac vaccine. However, the duration of the humoral immune response after administration of Gam-COVID-Vac and CoviVac was similar. Copyright © 2022, Media Sphera Publishing Group. All rights reserved.

Predictors of death within 6 months after non-ST elevation myocardial infarction in post-COVID-19 patients

Objective. To investigate predictors of death within six months of non-ST elevation myocardial infarction (NSTEMI) in post-COVID-19 patients. Material and methods. Outcomes were analyzed in 185 patients treated for NSTEMI at the Demikhov City Clinical Hospital from July 2020 to March 2021. Six months after discharge from the hospital, telephone interviews were conducted with treated patients, and in the absence of the possibility of personal contact, with their next of kin. During the survey, an assessment was made of the vital status (alive/dead), the presence of repeated hospitalizations and their causes. In the event of a patient's death, the cause of death was clarified on the basis of information received from relatives or from a unified medical information analytical system. Results. Overall mortality within 6 months after NSTEMI was 9.7% (n=18), in the COVID(+) group — 13.8% (n=13), in the COVID(-) group — 5.5% (n=5), p=0.0558. By causes of death, both groups are comparable (p>0.05). Median survival in patients in the COVID(+) group was 5.4 months (95% CI 5.1-5.7) and 5.9 months (95% CI 5.8-6.0) in patients in the COVID(-) group (X2=5.27;p=0.0217). The deceased and survivors were comparable in terms of gender and age (p>0.05). The deceased patients had lower baseline values of SpO2, hemoglobin, glomerular filtration rate (GFR) and had a higher score on the Syntax scale, C-re-active protein (CRP), creatinine (p<0.05). Patients had a history of COVID-19 in 72.2% (n=13) of lethal cases (p=0.0554). In 72.2% (n=13) of patients with a fatal outcome, multivessel coronary artery disease was noted (p<0.0001). With the development of NSTEMI within 28 days of COVID-19 disease, there was an increase in the risk of death (RR 33.2;p<0.0001). Predictors of the development of a lethal outcome after 6 months were an increase in the titer of IgG to SARS-CoV-2 ≥ 234.9 U/l, CRP ≥ 17.3 mg/l, a decrease in prothrombin time <9.5 s, GFR < 46.9 ml/l min/1.73 m2. Conclusion. Patients who survived COVID-19 showed a trend towards a higher incidence of deaths within 6 months. The development of a non-ST elevation myocardial infarction within 28 days of the onset of COVID-19 symptoms was accompanied by a significant increase in the chances of death within 6 months. A significant impact on the risk of death within 6 months was exerted by an increased level of C-reactive protein and IgG to SARS-CoV-2, a decrease in prothrombin time and glomerular filtration rate. © 2022, Media Sphera Publishing Group. All rights reserved.

Acute coronary syndrome in COVID-19 patients

Acute coronary syndrome (ACS) is caused by an acute mismatch between myocardial oxygen demand and its supply. This mechanism is largely associated with the progression of coronary atherosclerosis in combination with an inflammatory response, hypoxemia, and blood procoagulation. Patients with the coronavirus disease 2019 (COVID-19), aggravated by cardiovascular diseases and comorbidities, are at high risk of ACS. Aim. To analyze the publications, which reflects the development of ACS in patients with COVID-19, its pathogenesis, and clinical course. Material and methods. Literature data were searched using Google Scholar, PubMed, ScienceDirect, and Cyberleninka services. The analysis included data from clinical guidelines on COVID-19, data from clinical studies, reports, and systematic reviews. Results. This literature review summarizes and systematizes the data presented in modern publications, highlights the aspects of the clinical course and pathogenetic mechanisms underlying ACS in patients with COVID-19. Conclusion. The pathogenesis of COVID-19 is inextricably associated with the widespread cytopathic effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), uncontrolled immune response that causes systemic inflammation, as well as the coagulation system activation. In patients with COVID-19, along with the atherosclerosis, these mechanisms significantly increase the risk of ACS and can worsen its in-hospital course.