Angiographic characteristics of patients with STEMI and COVID-19: Insights from NACMI registry
Payam Dehghani1, Jyotpal Singh1, G B John Mancini2
1Prairie Vascular Research, Regina, Saskatchewan, Canada.
Insights
COVID-19 and ST-elevation myocardial infarction (STEMI) patients exhibit significant thrombus burden, leading to high rates of multivessel disease and stent thrombosis. Unsuccessful percutaneous coronary intervention (PCI) due to persistent thrombus impacts in-hospital mortality.
Area of Science:
- Cardiology
- Infectious Diseases
- Interventional Cardiology
Background:
- No prior independent core lab angiographic analysis existed for COVID-19 patients with ST-elevation myocardial infarction (STEMI).
- This study addresses the gap by characterizing angiographic parameters in this unique patient cohort.
Purpose of the Study:
- To conduct an independent core laboratory analysis of angiographic findings in patients with COVID-19 and STEMI.
- To assess culprit lesion characteristics, thrombus burden, and percutaneous coronary intervention (PCI) outcomes.
Main Methods:
- Angiograms from the North American COVID-19 Myocardial Infarction (NACMI) Registry were analyzed.
- Key parameters assessed included culprit lesion(s), Thrombolysis In Myocardial Infarction (TIMI) flow, Thrombus Grade Burden (TGB), and PCI outcomes.
Main Results:
- 74% of 234 patients had one culprit lesion; 27% had multivessel thrombotic disease.
- Stent thrombosis occurred in 12% of presentations, particularly in those with prior stents (55%).
- 33% of PCI procedures were unsuccessful, often due to persistent thrombus or suboptimal TIMI flow, and were associated with increased in-hospital mortality.
Conclusions:
- Patients with COVID-19 and STEMI present with substantial thrombus burden, multivessel disease, and stent thrombosis.
- Suboptimal PCI outcomes due to persistent thrombus remain a concern and are linked to mortality.
- These findings highlight the complex interplay between COVID-19 infection and acute coronary syndromes.
Background:
To date, there has been no independent core lab angiographic analysis of patients with COVID-19 and STEMI. The study characterized the angiographic parameters of patients with COVID-19 and STEMI.
Methods:
Angiograms of patients with COVID-19 and STEMI from the North American COVID-19 Myocardial Infarction (NACMI) Registry were sent to a Core Laboratory in Vancouver, Canada. Culprit lesion(s), Thrombolysis In Myocardial Infarction (TIMI) flow, Thrombus Grade Burden (TGB), and percutaneous coronary intervention (PCI) outcome were assessed.
Results:
From 234 patients, 74% had one culprit lesion, 14% had multiple culprits and 12% had no culprit identified. Multivessel thrombotic disease and multivessel CAD were found in 27% and 53% of patients, respectively. Stent thrombosis accounted for 12% of the presentations and occurred in 55% of patients with previous coronary stents. Of the 182 who underwent PCI, 60 (33%) had unsuccessful PCI due to post-PCI TIMI flow <3 (43/60), residual high thrombus burden (41/60) and/or thrombus related complications (27/60). In-hospital mortality for successful, partially successful, and unsuccessful PCI was 14%, 13%, and 27%, respectively. Unsuccessful PCI was associated with increased risk of in-hospital mortality (risk ratio [RR] 1.96; 95% CI: 1.05-3.66, P = .03); in the adjusted model this estimate was attenuated (RR: 1.24; 95% CI: 0.65-2.34, P = .51).
Conclusion:
In patients with COVID-19 and STEMI, thrombus burden was pervasive with notable rates of multivessel thrombotic disease and stent thrombosis. Post-PCI, persistent thrombus and sub-optimal TIMI 3 flow rates led to one-third of the PCI's being unsuccessful, which decreased over time but remained an important predictor of in-hospital mortality.
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