Features of diagnosis and treatment in patients with ST-segment elevation myocardial infarction and SARS-CoV-2 infection

Objectives. To evaluate clinical, laboratory, and instrumental features of diagnosis and treatment in patients with ST-segment elevation myocardial infarction (STEMI) and SARS-CoV-2 infection (COVID-19). Material and methods. The retrospective case-control study included 114 patients (57 pairs adjusted by gender, age, comorbidity and diagnosis of STEMI) who underwent coronary angiography (CAG). According to the temporary routing regulations for the pandemic in the Sverdlovsk region, in each pair one of the patients had been hospitalized with COVID-19 (group 1) at the Central City Hospital, Verchnya Pyshma, and the other person without COVID-19 (group 2) had been admitted to LLC Medical Association «Novaya Bolnica», Yekaterinburg. July to December 2020 medical records data were processed. Results. Patients with COVID-19 underwent PCI significantly later from the onset of symptoms, 607.0 (340.0–870.0) minutes versus 350.0 (190.0–450.0), p < 0.001. There were no difference in anatomy and the number of affected coronary arteries between the study groups. Massive coronary thrombosis was equally common in both groups, both with COVID-19 in 57.9% of cases and without COVID-19 in 56.1%, p = 0.849. Stenting attempts in the COVID-19 group were slightly less frequent and performed in 89.5% cases, while in patients without COVID-19 stenting occurred in 96.5% cases, p = 0.232. The optimal stenting result as TIMI 3 blood flow was obtained slightly less in the NCVI group: 94.2% versus 98.2% in patients without COVID-19, p = 0.067. COVID-19 positive subjects with STEMI required more days of hospitalization: 13.0 (10.0–18.0) versus 8.0 (8.0–8.0) in the group without COVID-19, p < 0.001. Conclusions. The manifestations of an infectious disease in cases of COVID-19 and STEMI comorbidity negatively affected the time from the onset of symptoms to the initiation of reperfusion therapy and caused a significantly longer duration of hospitalization. At the same time, timely routing decisions at the regional level to ensure the availability of primary PCI for all patients with STEMI, regardless of the presence of an infectious disease, allowed acceptable intervention results to be achieved in the vast majority of patients in both groups.

1. Ghasemzadeh N., Kim N., Amlani S., Madan M., Shavadia J.S., Chong A.Y. et al. A Review of ST-elevation myocardial infarction in patients with COVID-19. Cardiol. Clin. 2022;40(3):321–328. DOI: 10.1016/j.ccl.2022.03.007

2. Levi M., Thachil J., Iba T., Levy J.H. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020;7(6):e438–e440. DOI: 10.1016/S2352-3026(20)30145-9

3. Garcia S., Dehghani P., Grines C., Davidson L., Nayak K.R., Saw J. et al. Society for cardiac angiography and interventions, the Canadian association of interventional cardiology, and the american college of cardiology interventional council. initial fi ndings from the North American COVID-19 myocardial infarction registry. J. Am. Coll. Cardiol. 2021;77(16):1994–2003. DOI: 10.1016/j.jacc.2021.02.055

4. Dehghani P., Singh J., Mancini G.B.J., Stanberry L., Bergstedt S., Madan M. et al. Angiographic characteristics of patients with STEMI and COVID-19: Insights from NACMI registry. Am. Heart J. 2024;271:112–122. DOI: 10.1016/j.ahj.2024.02.012

5. 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

6. Levi A., Kornowski R., Vaduganathan M., Eisen A., Vaknin-Assa H., Abu-Foul S. et al. Incidence, predictors, and outcomes of failed primary percutaneous coronary intervention: a 10-year contemporary experience. Coron. Artery Dis. 2014;25(2):145–51. DOI: 10.1097/MCA.0000000000000065

7. Kedhi E., Joesoef K.S., McFadden E., Wassing J., van Mieghem C., Goedhart D., Smits P.C. Second-generation everolimus-eluting and paclitaxel-eluting stents in real-life practice (COMPARE): a randomised trial. Lancet. 2010;375(9710):201–9. DOI: 10.1016/S0140-6736(09)62127-9

8. Thakker R.A., Elbadawi A., Chatila K.F., Goel S.S., Reynoso D., Berbarie R.F. et al. Comparison of coronary artery involvement and mortality in STEMI patients with and without SARS-CoV-2 during the COVID-19 pandemic: a systematic review and metaanalysis. Curr. Probl. Cardiol. 2022;47(3):101032. DOI: 10.1016/j.cpcardiol.2021.101032