Pathogenesis of Acute Coronary Syndromes in Patients After COVID-19: An Optical Coherence Tomography Study

Background: Whilst COVID-19 mainly affects the lungs, multiple other organs were also involved-patients with COVID-19 were reported to be at higher risk of acute coronary syndromes (ACS). Importantly, results show that the risk of ACS may extend well beyond the acute phase of COVID-19 infection. In our study, we sought to investigate optical coherence tomography (OCT)-derived vascular changes, including the prevalence of plaque erosion in patients who had recent COVID-19. Methods: Patients with ACS were divided into two groups: those after COVID-19 infection during the past 12 months (post-COVID group) and those without known prior COVID infection (non-COVID group). We enrolled 35 patients in the post-COVID group and 35 patients in the non-COVID group. Results: The mean time from COVID infection to the imaging in the post-COVID group was 10 ± 1 months. There were no major differences in baseline demographic, clinical, or laboratory characteristics between the two groups. Erosion was the underlying pathology in one-third (34.3%) of the non-COVID group and in one-half (48.6%) of the post-COVID group, although the difference did not reach statistical significance. No calcified nodules were observed. The lipid core tended to be longer in the post-COVID group (9.1 ± 3.6 vs. 12.0 ± 1.9 mm; p = 0.005), and the prevalence of macrophages was higher in patients who had prior COVID-19 infection (48.6 vs. 74.3%; p = 0.027). Conclusions: Our OCT study demonstrated that patients with a prior COVID-19 infection tended to have a higher prevalence of plaque erosion and more vulnerable plaque morphology at the culprit lesion compared to those without a history of prior COVID-19 infection.