Coronavirus disease 2019 (COVID-19) can cause a wide range of cardiovascular diseases, including ST-segment elevation myocardial infarction (STEMI) and STEMI-mimickers (such as myocarditis, Takotsubo cardiomyopathy, among others). We performed a systematic review to summarize the clinical features, management, and outcomes of patients with COVID-19 who had ST-segment elevation. We searched electronic databases from inception to September 30, 2020 for studies that reported clinical data about COVID-19 patients with ST-segment elevation. Differences between patients with and without obstructive coronary artery disease (CAD) on coronary angiography were evaluated. Forty-two studies (35 case reports and seven case series) involving 161 patients were included. The mean age was 62.7 ± 13.6 years and 75% were men. The most frequent symptom was chest pain (78%). Eighty-three percent of patients had obstructive CAD. Patients with non-obstructive CAD had more diffuse ST-segment elevation (13% versus 1%, p = 0.03) and diffuse left ventricular wall-motion abnormality (23% versus 3%, p = 0.02) compared to obstructive CAD. In patients with previous coronary stent (n = 17), the 76% presented with stent thrombosis. In the majority of cases, the main reperfusion strategy was primary percutaneous coronary intervention instead of fibrinolysis. The in-hospital mortality was 30% without difference between patients with (30%) or without (31%) obstructive CAD. Our data suggest that a relatively high proportion of COVID-19 patients with ST-segment elevation had non-obstructive CAD. The prognosis was poor across groups. However, our findings are based on case reports and case series that should be confirmed in future studies. Supplementary Information The online version contains supplementary material available at 10.1007/s11239-021-02411-9.

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A 50-year-old man, a former smoker, presented with an ST-segment elevation anterior myocardial infarction that was treated with thrombolysis in another center. Because of the absence of reperfusion criteria, he was referred to our hospital for a rescue coronary intervention. A transthoracic echocardiogram showed that the overall left-ventricle systolic function was preserved but with apical akinesia. Coronary angiography revealed an occlusive lesion (100%) in the mid-left anterior descending coronary artery distal to a segment with a tapering caliber ( Figure 1A). At that time, the patient was asymptomatic, and, therefore, a conservative management was decided, including dual antiplatelet therapy and full anticoagulation. Biomarkers included elevated creatine kinase (peak: 926 U/L; n<190), creatine kinase-MB peak (peak: 36.4 ng/mL; n<5), and troponin I peak (peak: 15.90 ng/mL; n<0.2). A new coronary angiogram performed 7 days later revealed a complete recanalization of the left anterior descending coronary artery but with a very diffuse narrowing of its mid-segment (that persisted after nitroglycerin administration) with an abrupt recovery of vessel caliber near the apex ( Figure 1B). Optical coherence tomography accurately visualized the affected coronary wall along the entire vessel length unraveling the presence of a long intramural hematoma. The thickness and circumferential distribution of the intimomedial membrane was accurately depicted (Figure 2). The residual lumen size was preserved (3.2 mm 2 ), and an entry tear was not visualized. Ten days after admission, multislice computed tomography was performed, showing a very mild, diffuse, lumen narrowing, with a subtle wall thickening at the target segment ( Figure 1C). The patient was discharged after an uneventful hospitalization. At discharge, medications included 1-year dual antiplatelet therapy (aspirin/clopidogrel), β-adrenergic blockers, angiotensin-converting enzyme inhibitors, and statins. After a 6-month follow-up, the patient remained asymptomatic, and the echocardiogram displayed a complete recovery of the previous apical segmental motion abnormalities.Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome, typically affecting young otherwise healthy women.1 Dissection of the coronary intima or media is a hallmark finding, and hematoma formation deeper within the vessel wall is often present. It remains unclear whether dissection or hematoma is the primary event, but both may cause luminal stenosis and occlusion.1 Pressure-driven expansion of the false lumen induces axial propagation of the disease and true lumen compression, resulting in myocardial ischemia.2 However, angiography is sometimes unable to visualize the coronary wall, so its diagnostic accuracy for SCAD is often limited.3 However, intramural hematomas should be suspected in patients with otherwise completely smooth vessels (typically with curly or even corkscrew appearance) at segments showing a diffuse lumen narrowing that causes straighteni...

AIMTo investigate the rates and determinants of success of repeat percutaneous coronary intervention (PCI) following an initial failed attempt at recanalising the chronic total occlusions (CTO) percutaneously.METHODSIn 445 consecutive first attempt CTO-PCI procedures in our institution, procedural failure occurred in 149 (33.5%). Sixty-four re-PCI procedures were performed in 58 patients (39%) all had a single CTO. Procedural and outcome data in the re-PCI population was entered into the institutional database. A retrospective analysis of clinical, angiographic and procedural data was performed.RESULTSProcedural success was achieved in 41 (64%) procedures. Univariate analysis of clinical and angiographic characteristics showed that re-PCI success was associated with intravascular ultrasound (IVUS) guidance (19.5% vs 0%, P = 0.042), while failure was associated with severe calcification (30.4% vs 9.7%, P = 0.047) and a JCTO score > 3 (56.5% vs 17.1% P = 0.003). Following multiple regression analysis the degree of lesion complexity (J-CTO score > 3), IVUS use, involvement of an experienced CTO operator and LAD CTO location were significant predictors of successful re-PCI. Overall the complication rate was low, with the only MACCE two periprocedural MI’s neither of which required intervention.CONCLUSIONRe-PCI substantially increases the overall success rate of CTO revascularization. Predictors of re-PCI success included the use of IVUS, the involvement of an experienced CTO operator in the repeat attempt and the location of the CTO.