clinmedКлиническая медицинаClinical Medicine (Russian Journal)0023-21492412-1339ООО «Медицинское информационное агентство»10.30629/0023-2149-2025-103-4-300-308clinmed-1126Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL INVESTIGATIONSКлинико-лабораторные особенности острого инфаркта миокарда с подъемом сегмента ST электрокардиограммы, развившегося на фоне COVID-19Clinical and laboratory features of acute myocardial infarction with elevation of the ST segment of the electrocardiogram, which developed against the background of COVID-19https://orcid.org/0000-0001-8152-6474ИспавскийВ. Е.IspavskyV. E.

Испавский Владислав Евгеньевич — аспирант кафедры фармакологии и клинической фармакологии 

Екатеринбург

Vladislav E. Ispavsky – рostgraduate student at the Department of Pharmacology and Clinical Pharmacology

 Yekaterinburg

ispavsky@yandex.ruhttps://orcid.org/0000-0001-7826-9657ИзможероваН. В.IzmozherovaN. V.

 Изможерова Надежда Владимировна — д-р мед. наук., заведующий кафедрой фармакологии и клинической фармакологии; главный внештатный специалист-клинический фармаколог Минздрава Свердловской области

Екатеринбург

Nadezhda V. Izmozherova — Doctor of Medical Sciences, Head of the Department of Pharmacology and Clinical Pharmacology; Chief freelance specialist-Clinical Pharmacologist of the Ministry of Health of the Sverdlovsk Region

Yekaterinburg

https://orcid.org/0000-0001-6216-2468ПоповА. А.PopovA. A.

 Попов Артем Анатольевич — д-р мед. наук, заведующий кафедрой госпитальной терапии 

Екатеринбург

Artem A. Popov — Doctor of Medical Sciences, Head of the Department of Hospital Therapy

Yekaterinburg

https://orcid.org/0000-0002-8751-6872ЦветковА. И.TsvetkovA. I.

 Цветков Андрей Игоревич — д-р мед. наук, заведующий кафедрой общественного здоровья и здравоохранения 

Екатеринбург

 Andrey I. Tsvetkov — Doctor of Medical Sciences, Head of the Department of Public Health and Public Health

Yekaterinburg

https://orcid.org/0000-0002-9957-2505АнтроповаИ. П.AntropovaI. P.

 Антропова Ирина Петровна — д-р биол. наук, ведущий научный сотрудник Центральной научно-исследовательской лаборатории 

Екатеринбург

 Irina P. Antropova – Doctor of Biology, a leading researcher at the Central Research Laboratory

Yekaterinburg

https://orcid.org/0000-0003-3008-5124ЕрмаковВ. С.ErmakovV. S.

 Ермаков Валерий Сергеевич — врач-сердечно-сосудистый хирург, 2 кардиохирургическое отделение

Санкт-Петербург

Valeriy S. Ermakov — Cardiovascular surgeon, 2nd Cardiac Surgery Department

St. Petersburg

https://orcid.org/0000-0002-6337-104XКравчукВ. Н.KravchukV. N.

Кравчук Вячеслав Николаевич — д-р мед. наук, профессор, заведующий кафедрой сердечно-сосудистой хирургии  

Санкт-Петербург

Vyacheslav N. Kravchuk — Doctor of Medical Sciences, Professor, Head of the Department of Cardiovascular Surgery

St. Petersburg

ФГБОУ ВО «Уральский государственный медицинский университет» Минздрава РоссииРоссияUral State Medical University of the Ministry of Healthcare of RussiaRussian FederationФГБОУ ВО «Уральский государственный медицинский университет» Минздрава России; ФГБУН «Институт высокотемпературной электрохимии Уральского отделения РАН»РоссияUral State Medical University of the Ministry of Healthcare of Russia; Institute of High-Temperature Electrochemistry of the Ural Branch of the Russian Academy of SciencesRussian FederationФГБОУ ВО «Уральский государственный медицинский университет» Минздрава России; ФГБУН «Институт высокотемпературной электрохимии Уральского отделения РАН»РоссияUral State Medical University of the Ministry of Healthcare of Russia; Institute of High-Temperature Electrochemistry of the Ural Branch of the Russian Academy of SciencesRussian FederationФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава РоссииРоссияNorth-West State Medical University named after I.I. Mechnikоv of the Ministry of Healthcare of RussiaRussian Federation2025090820251034300308Copyright © Испавский В.Е., Изможерова Н.В., Попов А.А., Цветков А.И., Антропова И.П., Ермаков В.С., Кравчук В.Н., 20252025Испавский В.Е., Изможерова Н.В., Попов А.А., Цветков А.И., Антропова И.П., Ермаков В.С., Кравчук В.Н.Ispavsky V.E., Izmozherova N.V., Popov A.A., Tsvetkov A.I., Antropova I.P., Ermakov V.S., Kravchuk V.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.clinmedjournal.com/jour/article/view/1126

Цель. Оценить клинико-лабораторные особенности, госпитальные и отдаленные исходы острого инфаркта миокарда (ИМ) с подъемом сегмента ST электрокардиограммы (ИМпST), развившегося на фоне COVID-19. Материал и методы. В проспективное когортное исследование было включено 60 человек, сопоставимых по возрасту, полу и индексу полиморбидности Charlson. Пациенты были разделены на 3 группы по 20 человек: исследуемая группа — пациенты с ИМпST и COVID-19, и две группы сравнения — пациенты с ИМпST без COVID-19 и пациенты с COVID-19 без ИМпST. За время госпитализации проведен анализ клинической картины ИМпST и COVID-19, лабораторных, инструментальных, анамнестических данных, а также проведены генетическое исследование полиморфизмов генов SERPINE1, ITGB3 и ITGA2, оценка остаточной активности тромбоцитов и отдаленное наблюдение за пациентами после выписки из стационара. Результаты. У пациентов с выявленным COVID-19, независимо от ИМпST, чаще наблюдались симптомы данного инфекционного заболевания. У пациентов с ИМпST, независимо от наличия COVID-19, значительно чаще выявлялись боль в грудной клетке и положительный уровень тропонина I при поступлении в стационар. Группы пациентов с ИМпST не различались по основным ангиографическим характеристикам и техническим особенностям проведения чрескожного коронарного вмешательства, однако в группе с COVID-19 было значительно выше время «симптом-баллон» — 590 (340–870) против 305 (179–390), р < 0,001. Агрегация тромбоцитов с АДФ, адреналином и коллагеном была выше у пациентов с COVID-19, в том числе в группе ИМпST, по сравнению с группой ИМпST без COVID-19, р < 0,001. Пациенты с ИМпST и СOVID-19 нуждались в более длительной госпитализации — 11 (9,5–16,5) суток против 9,5 (7,0–13,5) в группе с COVID-19 без ИМпST и 7 (7–8) у пациентов с ИМпST без COVID-19, р < 0,001. У пациентов без COVID-19 не наблюдалось неблагоприятных сердечно-сосудистых событий в отдаленном периоде, тогда как в группе с ИМпST и СOVID-19 было зафиксировано 5 летальных исходов и 4 в группе COVID-19 без ИМпST, а также 4 случая нефатальных ИМ в группе ИМпST и СOVID-19 и 1 случай в группе COVID-19 без ИМпST, p = 0,032. Выводы. Смешанная клиническая картина инфекционного заболевания, вызванная COVID-19, и инфаркта миокарда могут повлиять на увеличение времени от начала симптомов до реперфузионной терапии, общее время госпитализации и худшие отдаленные исходы, такие как нефатальные ИМ и смерть.

Objectives. To evaluate the clinical, laboratory, and long-term outcomes of patients with acute myocardial infarction (MI) and ST elevation on the electrocardiogram (STEMI), which occurred during or after COVID-19 infection. Material and methods. A prospective cohort study included 60 participants, matched by age, gender, and the Charlson Comorbidity Index. The participants were divided into three groups of 20: the study group, which included patients with STEMI and COVID-19; a comparison group of patients with STEMI but without COVID-19; and a third comparison group consisting of patients with COVID-19 but without STEMI. During hospitalization, the clinical presentation of STEMI and COVID-19 was analyzed, as well as laboratory, instrumental data, and anamnesis. Additionally, a genetic study was conducted to examine polymorphisms in the SERPINE1, ITGB3, and ITGA2 genes. Residual platelet activity was assessed, and long-term follow-up was conducted after hospital discharge. Results. Patients with identified COVID-19, regardless of STEMI, more frequently exhibited symptoms of this infectious disease. Patients with STEMI, regardless of the presence of COVID-19, had significantly more chest pain and elevated troponin I levels upon admission to the hospital. The groups of patients with STEMI did not diff er in key angiographic characteristics and technical aspects of performing percutaneous coronary intervention; however, in the COVID-19 group, the “symptom-balloon” time was significantly longer — 590 (340 ÷ 870) minutes compared to 305 (179 ÷ 390) minutes in the group without COVID-19, p < 0.001. Platelet aggregation with ADP, adrenaline, and collagen was higher in patients with COVID-19, including those in the STEMI group, compared to the STEMI group without COVID-19, p < 0.001. Patients with STEMI and COVID-19 required a longer hospital stay — 11 (9.5 ÷ 16.5) days compared to 9.5 (7 ÷ 13.5) days in the COVID-19 group without STEMI and 7 (7 ÷ 8) days in patients with STEMI without COVID-19, p < 0.001. No adverse cardiovascular events were observed in the long term in patients without COVID-19, whereas in the STEMI and COVID-19 group, there were 5 fatalities recorded and 4 in the group with COVID-19 without STEMI, as well as 4 cases of non-fatal myocardial infarction in the STEMI and COVID-19 group and 1 case in the group with COVID-19 without STEMI, p = 0.032. Conclusions. The mixed clinical picture of the infectious disease caused by COVID-19 and myocardial infarction may influence an increase in the time from symptom onset to reperfusion therapy, overall hospitalization duration, and worse long-term outcomes such as non-fatal myocardial infarctions and death.

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The authors declare that there are no conflicts of interest present.