The Challenges of ST-Elevation Myocardial Infarction in COVID-19 Patients
Ju Young Bae1, Khalil Ian Hussein1, Christopher John Howes1,2
1Department of Medicine, Greenwich Hospital, Yale-New Haven Health System, 5 Perryridge Road, Greenwich, CT 06830, USA.
Insights
This study investigated ST-elevation myocardial infarction (STEMI) in COVID-19 patients. Three cases revealed STEMI associated with coronary artery disease and thrombus formation in SARS-CoV-2 infected individuals.
Area of Science:
- Cardiology
- Infectious Diseases
- Oncology
Background:
- COVID-19 has emerged as a significant global health crisis.
- Cardiovascular complications, including ST-elevation myocardial infarction (STEMI), are increasingly reported in SARS-CoV-2 infected patients.
- Concerns exist regarding a potential association between SARS-CoV-2 infection and increased thrombus burden.
Observation:
- A retrospective chart review was conducted on 535 adult patients admitted with COVID-19.
- Three patients were diagnosed with acute STEMI during their hospitalization.
- These patients underwent laboratory testing, electrocardiogram (ECG), and echocardiography.
Findings:
- Angiography confirmed obstructive coronary artery disease in all three STEMI patients.
- One patient presented with vasospasm, coronary atherosclerotic obstruction, and refractory thrombus formation.
- Presentations of STEMI in COVID-19 patients varied regarding symptom onset, demographics, comorbidities, and outcomes.
Implications:
- The findings suggest a complex interplay between COVID-19, coronary artery disease, and acute myocardial infarction.
- Further research is warranted to elucidate the mechanisms linking SARS-CoV-2 infection to STEMI and heightened thrombotic risk.
- Understanding these associations is crucial for optimizing clinical management and patient outcomes in the context of the pandemic.
Abstract:
By July 2021, the United States had over 34.4 million confirmed COVID-19 cases. Various cardiovascular manifestations of COVID-19 have been reported including ST-elevation myocardial infarction (STEMI), and there is concern that SARS-CoV-2 may be associated with a higher thrombus burden. We performed a retrospective chart review of 535 adult patients with COVID-19 admitted at Yale-New Haven Health Greenwich Hospital from February 1, 2020, to May 13, 2020. All admitted patients had undergone testing for serum troponin I and various inflammatory markers, and we identified three patients who were diagnosed with acute STEMI. Data was collected via manual chart review and included patient demographics, comorbidities, laboratory tests, electrocardiogram (ECG) results, echocardiography results, diagnoses during hospitalization, inpatient therapies, and outcomes including length of hospital stay, revascularization results, and mortality. Three of our patients had obstructive coronary artery disease confirmed via angiography. One subject was noted to display vasospasm in addition to coronary atherosclerotic obstruction and refractory thrombus formation. Among our patients with COVID-19 and STEMI, presentations were variable in terms of timing of onset of ECG changes, age, gender, race, comorbidities, symptomology, and outcomes.
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