ST-segment elevation in patients with COVID-19: a systematic review

Area of Science:

• Cardiology
• Infectious Diseases
• Internal Medicine

Background:

• Coronavirus disease 2019 (COVID-19) is associated with various cardiovascular complications.
• ST-segment elevation in COVID-19 patients can indicate ST-segment elevation myocardial infarction (STEMI) or mimic conditions like myocarditis.

Purpose of the Study:

• To systematically review the clinical features, management, and outcomes of COVID-19 patients presenting with ST-segment elevation.
• To compare outcomes between patients with and without obstructive coronary artery disease (CAD).

Main Methods:

• Systematic review of electronic databases (inception to September 30, 2020).
• Inclusion of 42 studies (35 case reports, 7 case series) with 161 COVID-19 patients exhibiting ST-segment elevation.
• Analysis of clinical data, including coronary angiography findings.

Main Results:

• The majority of patients (78%) presented with chest pain.
• Eighty-three percent had obstructive coronary artery disease (CAD).
• Patients with non-obstructive CAD showed more diffuse ST-segment elevation and left ventricular wall-motion abnormalities.
• Stent thrombosis occurred in 76% of patients with prior stents.
• In-hospital mortality was 30% overall, with no significant difference between obstructive and non-obstructive CAD groups.

Conclusions:

• A significant proportion of COVID-19 patients with ST-segment elevation had non-obstructive CAD.
• Prognosis was poor for all patients, regardless of CAD status.
• Findings are based on limited data (case reports/series) and require confirmation by larger studies.