Atypical ST-Segment-Elevation Myocardial Infarction Presentation in Patients With COVID-19 at a High-Volume Center in New York City

Abstract

Atypical presentations of ST-segment-elevation myocardial infarction (STEMI) have been reported in patients who have COVID-19. We have seen this occurrence in our center in Bronx, New York, where multitudes of patients sought treatment for the coronavirus. We studied the prevalence of atypical STEMI findings among patients with COVID-19 who presented during the first 2 months of the pandemic. Consistent with previous reports, 4 of our 10 patients with COVID-19 and STEMI had no identifiable culprit coronary lesion; rather, they often had diffuse ST-segment elevations on surface electrocardiograms along with higher levels of D-dimer and inflammatory markers. In contrast, 32 of 33 patients without COVID-19 (97%) had a culprit lesion. The patients with COVID-19 and a culprit lesion more often needed thrombectomy catheterization and administration of glycoprotein IIb/IIIa inhibitors. Our study confirms that patients with COVID-19 often have atypical STEMI presentations, including the frequent absence of a culprit coronary lesion. Our findings can help clinicians prepare for these atypical clinical presentations.

COVID-19 as an independent predictor of aspiration thrombectomy in STEMI. National data from the ORPKI register in the years 2020–2022

“…Equally quickly, a different course of STEMI in the course of SARS-CoV2 infection began to be observed. It was found that some of the infected patients undergoing invasive examination did not have an identifiable coronary lesion [ 12 ], and the occurrence of non-obstructive coronary artery disease was significantly more frequently observed in COVID-19 STEMI than in the control group (13% vs. 1%, p = 0.03) [ 13 ]. In addition, there have been reports that this problem occurred with an increased frequency in women (1/3 of women vs. 1/5 of men) [ 14 ].…”

COVID-19 and the Heart: Could Transient Takotsubo Cardiomyopathy Be Related to the Pandemic by Incidence and Mechanisms?

“…De novo hypercoagulability, resulting in vessel thrombosis and occasional patchy ischemic damage to multiple parenchymal tissues ( 9 , 12 , 13 , 15 – 17 , 22 , 26 , 28 , 29 );…”

“…Acute myocardial infarction (AMI), although generally rare, is caused by epicardial coronary artery thrombosis (probably induced by sudden progression of preexisting unstable, atherosclerotic soft plaques activated by systemic inflammation, hypercoagulable state, endothelial damage, or hypertensive spells) ( 29 , 33 ). Localized segmental hypokinesia (more than 1 cm 2 in echocardiographic area) correlates with ECG changes and, although rare, makes a strong clinical case for AMI ( 26 ).…”