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Changes in characteristics and management among patients with ST-elevation myocardial infarction due to COVID-19 infection.
Popovic, Batric; Varlot, Jeanne; Metzdorf, Pierre Adrien; Jeulin, Hélène; Goehringer, François; Camenzind, Edoardo.
  • Popovic B; Département de Cardiologie, CHU Nancy, Nancy, France.
  • Varlot J; Département de Cardiologie, CHU Nancy, Nancy, France.
  • Metzdorf PA; Département de Cardiologie, CHU Nancy, Nancy, France.
  • Jeulin H; Laboratoire de Virologie, Service de Microbiologique, Nancy, France.
  • Goehringer F; Service de Maladies Infectieuses et Tropicales, CHU de Nancy, Bâtiment Philippe Canton, Nancy, France.
  • Camenzind E; Département de Cardiologie, CHU Nancy, Nancy, France.
Catheter Cardiovasc Interv ; 97(3): E319-E326, 2021 Feb 15.
Article in English | MEDLINE | ID: covidwho-644776
ABSTRACT

OBJECTIVES:

To assess changes in characteristics and management among ST-elevation myocardial infarction (STEMI) patients with coronavirus disease (COVID-19) who underwent primary percutaneous coronary intervention.

METHODS:

Our prospective, monocentric study enrolled all STEMI patients who underwent PPCI during the COVID-19 outbreak (n = 83). This cohort was first compared with a previous cohort of STEMI patients (2008-2017, n = 1,552 patients) and was then dichotomized into a non-COVID-19 group (n = 72) and COVID-19 group (n = 11).

RESULTS:

In comparison with the pre-outbreak period, patients during the outbreak period were older (59.6 ± 12.9 vs. 62.6 ± 12.2, p = .03) with a delayed seek to care (mean delay first symptoms-balloon 3.8 ± 3 vs. .7.4 ± 7.7, p < .001) resulting in a two-fold higher in-hospital mortality (non COVID-19 4.3% vs. COVID-19 8.4%, p = .07). Among the 83 STEMI patients admitted during the outbreak period, 11 patients were infected by COVID-19. Higher biological markers of inflammation (C-reactive protein 28 ± 39 vs. 98 ± 97 mg/L, p = .04), of fibrinolysis (D-dimer 804 ± 1,500 vs. 3,128 ± 2,458 µg/L, p = .02), and antiphospholipid antibodies in four cases were observed in the COVID-19 group. In this group, angiographic data also differed a thrombotic myocardial infarction nonatherosclerotic coronary occlusion (MINOCA) was observed in 11 cases (1.4% vs. 54.5%, p < .001) and associated with higher post-procedure distal embolization (30.6% vs. 72.7%, p = .007). The in hospital mortality was significantly higher in the COVID-19 group (5.6% vs. 27.3%, p = .016).

CONCLUSION:

The COVID-19 outbreak implies deep changes in the etiopathogenesis and therapeutic management of STEMI patients with COVID-19. The impact on early and long-term outcomes of systemic inflammation and hypercoagulability in this specific population is warranted.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: ST Elevation Myocardial Infarction / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Catheter Cardiovasc Interv Journal subject: Cardiology Year: 2021 Document Type: Article Affiliation country: Ccd.29114

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Full text: Available Collection: International databases Database: MEDLINE Main subject: ST Elevation Myocardial Infarction / COVID-19 Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Catheter Cardiovasc Interv Journal subject: Cardiology Year: 2021 Document Type: Article Affiliation country: Ccd.29114