ST-Elevation Myocardial Infarction in Patients With COVID-19

Abstract

oronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is causing a dramatic pandemic. 1ombardy, in northern Italy, is one of the most affected regions worldwide. 2ardiovascular complications occur frequently in patients with COVID-19, 3 with challenges in acute management.We aimed to evaluate incidence, clinical presentation, angiographic findings, and clinical outcomes of ST-elevation myocardial infarction (STEMI) in patients with COVID-19.All hospitals with catherization laboratories in Lombardy were contacted to collect cases of patients with confirmed COVID-19 who underwent an urgent coronary angiogram because of STEMI between February 20, 2020 (date of first COVID-19 case in Lombardy) and March 30, 2020. 2 Data were collected retrospectively, in anonymized fashion without any sensitive data, therefore not requiring institutional review board approval.COVID-19 was confirmed with reverse transcription-polymerase chain reaction assays.STEMI was defined based on the presence of typical symptoms associated with ST-segment elevation or new left bundle-branch block. 4A stenosis was considered as the culprit lesion in case of angiographic evidence of thrombotic occlusion/subocclusion.Obstructive coronary artery disease was defined based on the angiographic evidence of a stenosis >50% on visual estimation.A total of 28 patients with COVID-19 with STEMI were included.All patients met the guideline definition of STEMI 4 with localized ST-elevation (25 patients, 89.3%) or new left bundle-branch block (3 patients, 10.7%), and all were treated in the setting of emergent activation.The Table displays a detailed overview of each included patient.The mean age was 68±11 years, 8 patients (28.6%) were women, 20 (71.4%) had arterial hypertension, 9 (32.1%) had diabetes mellitus, 8 (28.6%) had chronic kidney disease, and 3 (10.7%)had a previous myocardial infarction.For 24 patients (85.7%), the STEMI represented the first clinical manifestation of COVID-19, and they did not have a COVID-19 test result at the time of coronary angiography.The remaining 4 patients had STEMI during hospitalization for COVID-19.Twenty-two patients (78.6%) presented with typical chest pain associated with or not associated with dyspnea, and 6 patients (21.4%) had dyspnea without chest pain.On echocardiography, 23 patients (82.1%) had localized wall motion abnormalities, 3 (10.7%)had diffuse hypokinesia, and 2 (7.1%) did not have abnormalities.The left ventricular ejection fraction was <50% in 17 patients (60.7%).All patients underwent urgent coronary angiography, and none was treated with fibrinolysis.Out of 28 patients, 17 patients (60.7%) had evidence of a culprit lesion requiring revascularization, and 11 patients (39.3%) did not have obstructive coronary artery disease.