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High Thrombus Burden in Patients With COVID-19 Presenting With ST-Segment Elevation Myocardial Infarction

Fizzah A Choudry1, Stephen M Hamshere1, Krishnaraj S Rathod1

  • 1Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.

Journal of the American College of Cardiology
|July 18, 2020
PubMed

Insights

Patients with ST-segment elevation myocardial infarction (STEMI) and COVID-19 infection show increased clot burden and worse outcomes. Establishing COVID-19 status in STEMI cases is crucial for understanding and managing these thrombotic events.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Thrombosis

Background:

  • COVID-19 is linked to thrombotic disease, but reports of STEMI in these patients are limited.
  • Type 1 myocardial infarction in COVID-19 patients requires further investigation.

Purpose of the Study:

  • To compare demographic, angiographic, procedural, and clinical outcomes of COVID-19-positive STEMI patients versus COVID-19-negative patients.
  • To identify characteristics associated with STEMI in COVID-19 patients.

Main Methods:

  • Single-center, observational study of 115 consecutive STEMI patients.
  • Primary percutaneous coronary intervention performed between March 1, 2020, and May 20, 2020.
  • Comparison of clinical data between COVID-19-positive and COVID-19-negative STEMI cohorts.

Main Results:

  • COVID-19 positive STEMI patients had higher troponin T, elevated D-dimer and C-reactive protein, and lower lymphocyte counts.
  • Increased rates of multivessel thrombosis, stent thrombosis, and higher thrombus burden were observed in COVID-19 positive patients.
  • Poorer myocardial blush grade, reduced left ventricular function, longer hospital stays, and higher ICU admissions were noted in COVID-19 positive STEMI patients.

Conclusions:

  • Concurrent COVID-19 infection in STEMI patients signals higher thrombus burden and poorer outcomes.
  • Testing for COVID-19 in all STEMI cases is recommended.
  • Further research is needed to elucidate the mechanisms of increased thrombosis and the efficacy of aggressive antithrombotic therapies.
Abstract

Keywords:
COVID-19ST-segment elevation myocardial infarctionprimary percutaneous coronary interventionthrombosis

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