Article ; Online: High Thrombus Burden in Patients With COVID-19 Presenting With ST-Segment Elevation Myocardial Infarction.
Journal of the American College of Cardiology
2020 Volume 76, Issue 10, Page(s) 1168–1176
Abstract: ... by type 1 myocardial infarction in patients with COVID-19.: Objectives: The aim of this study was ... disease. To date there are few reports of ST-segment elevation myocardial infarction (STEMI) caused ... and concurrent COVID-19 infection, there is a strong signal toward higher thrombus burden and poorer ...
Abstract | Background: Coronavirus disease-2019 (COVID-19) is thought to predispose patients to thrombotic disease. To date there are few reports of ST-segment elevation myocardial infarction (STEMI) caused by type 1 myocardial infarction in patients with COVID-19. Objectives: The aim of this study was to describe the demographic, angiographic, and procedural characteristics alongside clinical outcomes of consecutive cases of COVID-19-positive patients with STEMI compared with COVID-19-negative patients. Methods: This was a single-center, observational study of 115 consecutive patients admitted with confirmed STEMI treated with primary percutaneous coronary intervention at Barts Heart Centre between March 1, 2020, and May 20, 2020. Results: Patients with STEMI presenting with concurrent COVID-19 infection had higher levels of troponin T and lower lymphocyte count, but elevated D-dimer and C-reactive protein. There were significantly higher rates of multivessel thrombosis, stent thrombosis, higher modified thrombus grade post first device with consequently higher use of glycoprotein IIb/IIIa inhibitors and thrombus aspiration. Myocardial blush grade and left ventricular function were significantly lower in patients with COVID-19 with STEMI. Higher doses of heparin to achieve therapeutic activated clotting times were also noted. Importantly, patients with STEMI presenting with COVID-19 infection had a longer in-patient admission and higher rates of intensive care admission. Conclusions: In patients presenting with STEMI and concurrent COVID-19 infection, there is a strong signal toward higher thrombus burden and poorer outcomes. This supports the need for establishing COVID-19 status in all STEMI cases. Further work is required to understand the mechanism of increased thrombosis and the benefit of aggressive antithrombotic therapy in selected cases. |
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MeSH term(s) | Aged ; Betacoronavirus/isolation & purification ; C-Reactive Protein/analysis ; COVID-19 ; Comorbidity ; Coronary Angiography/methods ; Coronary Thrombosis/blood ; Coronary Thrombosis/diagnosis ; Coronary Thrombosis/etiology ; Coronavirus Infections/blood ; Coronavirus Infections/complications ; Coronavirus Infections/diagnosis ; Coronavirus Infections/epidemiology ; Female ; Fibrin Fibrinogen Degradation Products/analysis ; Fibrinolytic Agents/therapeutic use ; Humans ; Lymphocyte Count/methods ; Male ; Middle Aged ; Outcome and Process Assessment, Health Care ; Pandemics ; Patient Selection ; Percutaneous Coronary Intervention/methods ; Pneumonia, Viral/blood ; Pneumonia, Viral/complications ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/epidemiology ; SARS-CoV-2 ; ST Elevation Myocardial Infarction/epidemiology ; ST Elevation Myocardial Infarction/therapy ; Severity of Illness Index ; Troponin T/blood |
Chemical Substances | Fibrin Fibrinogen Degradation Products ; Fibrinolytic Agents ; Troponin T ; fibrin fragment D ; C-Reactive Protein (9007-41-4) |
Keywords | covid19 |
Language | English |
Publishing date | 2020-07-14 |
Publishing country | United States |
Document type | Journal Article ; Observational Study |
ZDB-ID | 605507-2 |
ISSN | 1558-3597 ; 0735-1097 |
ISSN (online) | 1558-3597 |
ISSN | 0735-1097 |
DOI | 10.1016/j.jacc.2020.07.022 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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