Frequency and predictors of no-reflow phenomenon in patients with COVID-19 presenting with ST-segment elevation myocardial infarction.

OBJECTIVES: Thrombotic process is triggered in the course of Coronavirus disease-2019 (COVID-19), which is a global pandemic, and both arterial and venous systems are affected. ST-elevation myocardial infarction (STEMI) that may develop in these patients may cause more complicated results with the effect of thrombosis burden. Our aim in this study is to determine the frequency of no-reflow phenomenon in COVID-19 patients with STEMI and to determine the factors that predict this complication. METHODS: In this study, which is a single-centre, retrospective and observational, a total of 126 patients who underwent primary percutaneous coronary intervention (pPCI) in our centre due to STEMI between 11 March 2020 and 10 January 2021 were evaluated. Patients were divided into two groups according to the presence of COVID-19 infection. RESULTS: While 62 patients were in the COVID-19 (+) group, 64 patients were evaluated in the COVID-19 (-) group. When the two groups are compared, C-reactive protein, D-dimer, ferritin and neutrophil-lymphocyte ratio (NLR) were significantly higher, and the lymphocyte count was significantly lower in the COVID-19 (+) group. No-reflow was numerically higher in patients with COVID-19. In multivariable analysis, D-dimer and NLR were found to be independent predictors of no-reflow phenomenon in COVID-19 patients. CONCLUSIONS: Although the no-reflow phenomenon was numerically higher in COVID-19 patients who underwent pPCI due to STEMI compared to the non-COVID group, no statistical difference was found in our study. However, NLR and D-dimer have been identified as independent predictors of no-reflow development risk in COVID-19 patients.

Evaluation of endothelial dysfunction in COVID-19 with flow-mediated dilatation (preprint)

Aim: It is a well-known fact that inflammation plays a crucial role in many diseases including COVID-19. Using flow-mediated dilatation (FMD), we aimed to compare the effects of inflammation on endothelial dysfunction in patients with COVID-19 and the control group. Materials and Methods: The present study was conducted on a total of 161 participants, of whom 80 were diagnosed with COVID-19 within the last 6 months (comprising 48 women and 32 men with a mean age of 32.10 ± 5.87 years) and 81 were healthy controls (comprising 45 women and 36 men with a mean age of 30.51 ± 7.33 years). We analyzed the findings of transthoracic echocardiography and FMD in all participants. Results: Except for FMD, there was no statistically significant difference in echocardiographic parameters. (9.52 ± 5.98 vs. 10.53 ± 6.31, p=0.010). In multivariate analysis with the forward stepwise model, FMD was significantly different in the control group compared to the COVID group (1.086 (1.026 - 1.149), p=0.04). Spearman’s correlation test indicated that FMD (r=0.27, p=0.006) had a significantly positive correlation with the presence of COVID. A receiver operating curve analysis revealed that an FMD value of <10.62% was capable of predicting the presence of COVID with a sensitivity and specificity of 64% and 59%, respectively (AUC=0.625, 95% CI, 0.538 - 0.711). Conclusion: The value of FMD decreased significantly in COVID-19 patients compared to the healthy subjects, which may be an early marker for COVID-19 induced endothelial dysfunction. KEYWORDS: COVID-19, endothelial dysfunction, flow-mediated dilatation (FMD