Clinical and laboratory features of acute myocardial infarction with elevation of the ST segment of the electrocardiogram, which developed against the background of COVID-19

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.

1. Levi M., Thachil J., Iba T., Levy J.H. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020;7(6):438–440.DOI 10.1016/S2352-3026(20)30145-9

2. Bikdeli B., Madhavan M.V., Jimenez D., Chuich T., Dreyfus I., Driggin E. et al. Global COVID-19 Thrombosis Collaborative Group., Endorsed by the ISTH., NATF., ESVM, and the IUA, Supported by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function. COVID-19 and Thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review. J. Am. Coll. Cardiol. 2020;75(23):2950–2973. DOI 10.1016/j.jacc.2020.04.03

3. Kermani-Alghoraishi M. A Review of coronary artery thrombosis: a new challenging fi nding in COVID-19 patients and st-elevation myocardial infarction. Curr. Probl. Cardiol. 2021;46(3):100744. DOI 10.1016/j.cpcardiol.2020.100744

4. Rodriguez-Leor O., Cid Alvarez A.B., Pérez de Prado A., Rossello X., Ojeda S., Serrador A. et al. In-hospital outcomes of COVID-19 ST-elevation myocardial infarction patients. EuroIntervention. 2021;16(17):1426–1433. DOI 10.4244/EIJ-D-20-00935

5. Sutherland N., Dayawansa N.H., Filipopoulos B., Vasanthakumar S., Narayan O., Ponnuthurai F.A., van Gaal W. Acute coronary syndrome in the COVID-19 pandemic: reduced cases and increased ischaemic time. Heart Lung Circ. 2022;31(1):69–76. DOI 10.1016/j.hlc.2021.07.023

6. Halushka M.K., Vander Heide R.S. Myocarditis is rare in COVID-19 autopsies: cardiovascular fi ndings across 277 postmortem examinations. Cardiovasc. Pathol. 2021;50:107300. DOI 10.1016/j.carpath.2020.107300

7. Pecoraro A.J.K., Herbst P.G., Joubert L.H. Dwindling myocardial infarctions. Eur Heart J. 2020;41(37):3497–3499. DOI 10.1093/eurheartj/ehaa619

8. Zitelny E., Newman N., Zhao D. STEMI during the COVID-19 pandemic - an evaluation of incidence. Cardiovasc. Pathol. 2020;48:107232. DOI 10.1016/j.carpath.2020.107232

9. Cliff ord C.R., Le May M., Chow A., Boudreau R., Fu A.Y.N., Barry Q., Chong A.Y., So D.Y.F. Delays in ST-elevation myocardial infarction care during the COVID-19 lockdown: an observational study. CJC Open. 2020;3(5):565–73. DOI 10.1016/j.cjco.2020.12.009

10. De Luca G., Algowhary M., Uguz B., Oliveira D.C., Ganyukov V., Zimbakov Z. et al. ISACS-STEMI COVID-19; Collaborators. COVID-19 pandemic, mechanical reperfusion and 30-day mortality in ST elevation myocardial infarction. Heart. 2022;108(6):458–466. DOI 10.1136/heartjnl-2021-319750

11. Chieff o A., Stefanini G.G., Price S., Barbato E., Tarantini G., Karam N. et al. EAPCI position statement on invasive management of acute coronary syndromes during the COVID-19 pandemic. Eur. Heart J. 2020;41(19):1839–1851. DOI 10.1093/eurheartj/ehaa381

12. Matsushita K., Hess S., Marchandot B., Sato C., Truong DP., Kim N.T. et al. Clinical features of patients with acute coronary syndrome during the COVID-19 pandemic. J Thromb Thrombolysis. 2021;52(1):95–104. DOI 10.1007/s11239-020-02340-z

13. Basso C., Leone O., Rizzo S., De Gaspari M., van der Wal A.C., Aubry M.C. et al. Pathological features of COVID-19-associated myocardial injury: a multicentre cardiovascular pathology study. Eur. Heart J. 2020;41(39):3827–3835. DOI 10.1093/eurheartj/ehaa664

14. Chieff o A., Stefanini G.G., Price S., Barbato E., Tarantini G., Karam N. et al. EAPCI Position statement on invasive management of acute coronary syndromes during the COVID-19 pandemic. Eur. Heart J. 2020;41(19):1839–1851. DOI 10.1093/eurheartj/ehaa381

15. Hilton J., Boyer N., Nadim M.K., Forni L.G., Kellum J.A. COVID-19 and Acute Kidney Injury. Crit Care Clin. 2022;38(3):473–489. DOI 10.1016/j.ccc.2022.01.002

16. Choudry F.A., Hamshere S.M., Rathod K.S., Akhtar M.M., Archbold R.A., Guttmann O.P. et al. High thrombus burden in patients with COVID-19 presenting with ST-segment elevation myocardial infarction. J. Am. Coll. Cardiol. 2020;76(10):1168–1176. DOI 10.1016/j.jacc.2020.07.022

17. Lunardi M., Mamas M.A., Mauri J., Molina C.M., Rodriguez Leor O., Eggington S. et al. We CARE Initiative. Predicted clinical and economic burden associated with reduction in access to acute coronary interventional care during the COVID-19 lockdown in two European countries. Eur. Heart J. Qual. Care Clin. Outcomes. 2024;10(1):25–35. DOI 10.1093/ehjqcco/qcad025

18. De Luca G., Silverio A., Verdoia M., Siudak Z., Tokarek T., Kite T.A. et al. Angiographic and clinical outcome of SARS-CoV-2 positive patients with ST-segment elevation myocardial infarction undergoing primary angioplasty: A collaborative, individual patient data meta-analysis of six registry-based studies. Eur. J. Intern. Med. 2022;105:69–76. DOI 10.1016/j.ejim.2022.08.021

19. Reyes L.F., Garcia-Gallo E., Murthy S., Fuentes Y.V., Serrano C.C., Ibáñez-Prada E.D.et al. ISARIC Characterisation Group. Major adverse cardiovascular events (MACE) in patients with severe COVID-19 registered in the ISARIC WHO clinical characterization protocol: A prospective, multinational, observational study. J. Crit. Care. 2023;77:154318. DOI 10.1016/j.jcrc.2023.154318