The Challenge of High Coronary Thrombotic Events in Patients with ST-Segment Elevation Myocardial Infarction and COVID-19

• Published in: Journal of clinical medicine Vol. 11; no. 21; p. 6542
• Main Authors: Anghel, Larisa, Tudurachi, Bogdan-Sorin, Leonte, Andreea, Sascău, Radu Andy, Zota, Ioana Mădălina, Bazyani, Amin, Tinică, Grigore, Stătescu, Cristian
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 04-11-2022; MDPI
• Subjects: Cardiovascular disease; Clinical medicine; Coronaviruses; COVID-19; Mortality; Romania; COVID-19; in-hospital mortality; STEMI; coronary disease; SARS-CoV-2; thrombotic events
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm11216542

The aim of this observational study was to describe the characteristics and outcomes of coronavirus disease 2019 (COVID-19)-positive patients with ST-segment elevation myocardial infarction (STEMI), with a special focus on factors associated with a high risk of coronary thrombosis and in-hospital mortality. Comparing the two groups of patients with STEMI separated according to the presence of SARS-CoV-2 infections, it was observed that COVID-19 patients were more likely to present with dyspnea (82.43% vs. 61.41%, p = 0.048) and cardiogenic shock (10.52% vs. 5.40%, p = 0.012). A longer total ischemia time was observed in COVID-19 patients, and they were twice as likely to undergo coronary angiography more than 12 hours after the onset of symptoms (19.29% vs. 10.13%, p = 0.024). In 10 of 57 COVID-19-positive patients, a primary PCI was not necessary, and only thromboaspiration was performed (17.54% vs. 2.70%, p < 0.001). Platelet level was inversely correlated (r = −0.512, p = 0.025) with a higher risk of coronary thrombosis without an atherosclerotic lesion. Using a cut-off value of 740 ng/ml, D-dimers predicted a higher risk of coronary thrombosis, with a sensitivity of 80% and a specificity of 66% (ROC area under the curve: 0.826, 95% CI: 0.716−0.935, p = 0.001). These are novel findings that raise the question of whether more aggressive antithrombotic therapy is necessary for selected COVID-19 and STEMI patients.