Complicated myocardial infarction in a 99-year-old lady in the era of COVID-19 pandemic: from the need to rule out coronavirus infection to emergency percutaneous coronary angioplasty

Sgura, Fabio; Arrotti, Salvatore; Cappello, C.; Boriani, Giuseppe

doi:10.1007/s11739-020-02362-8

Cited by 6 publications

(6 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It has been postulated that increased systematic and intraplaque inflammatory activity, persistent destabilization of the plaques, and the prothrombotic and procoagulant state may collectively cause myocardial infarction in these acute respiratory infections 35 . Acute infection triggered myocardial infarction has been observed in COVID-19 patients, especially in severe patients 18 , 36 - 38 . Shi found that 14 out of 416 patients (3.36%) may have developed myocardial ischemia, with features consistent with ST-elevation myocardial infarction 18 .…”

Section: Discussionmentioning

confidence: 99%

Myocardial injury and COVID-19: Serum hs-cTnI level in risk stratification and the prediction of 30-day fatality in COVID-19 patients with no prior cardiovascular disease

Cao¹,

Zheng²,

Luo³

et al. 2020

Theranostics

View full text Add to dashboard Cite

Introduction: To explore the involvement of the cardiovascular system in coronavirus disease 2019 (COVID-19), we investigated whether myocardial injury occurred in COVID-19 patients and assessed the performance of serum high-sensitivity cardiac Troponin I (hs-cTnI) levels in predicting disease severity and 30-day in-hospital fatality. Methods: We included 244 COVID-19 patients, who were admitted to Renmin Hospital of Wuhan University with no preexisting cardiovascular disease or renal dysfunction. We analyzed the data including patients' clinical characteristics, cardiac biomarkers, severity of medical conditions, and 30-day in-hospital fatality. We performed multivariable Cox regressions and the receiver operating characteristic analysis to assess the association of cardiac biomarkers on admission with disease severity and prognosis. Results: In this retrospective observational study, 11% of COVID-19 patients had increased hs-cTnI levels (>40 ng/L) on admission. Of note, serum hs-cTnI levels were positively associated with the severity of medical conditions (median [interquartile range (IQR)]: 6.00 [6.00-6.00] ng/L in 91 patients with moderate conditions, 6.00 [6.00-18.00] ng/L in 107 patients with severe conditions, and 11.00 [6.00-56.75] ng/L in 46 patients with critical conditions, P for trend=0.001). Moreover, compared with those with normal cTnI levels, patients with increased hs-cTnI levels had higher in-hospital fatality (adjusted hazard ratio [95% CI]: 4.79 [1.46-15.69]). The receiver-operating characteristic curve analysis suggested that the inclusion of hs-cTnI levels into a panel of empirical prognostic factors substantially improved the prediction performance for severe or critical conditions (area under the curve (AUC): 0.71 (95% CI: 0.65-0.78) vs. 0.65 (0.58-0.72), P =0.01), as well as for 30-day fatality (AUC: 0.91 (0.85-0.96) vs. 0.77 (0.62-0.91), P =0.04). A cutoff value of 20 ng/L of hs-cTnI level led to the best prediction to 30-day fatality. Conclusions: In COVID-19 patients with no preexisting cardiovascular disease, 11% had increased hs-cTnI levels. Besides empirical prognostic factors, serum hs-cTnI levels upon admission provided independent prediction to both the severity of the medical condition and 30-day in-hospital fatality. These findings may shed important light on the clinical management of COVID-19.

show abstract

Section: Discussionmentioning

confidence: 99%

Myocardial injury and COVID-19: Serum hs-cTnI level in risk stratification and the prediction of 30-day fatality in COVID-19 patients with no prior cardiovascular disease

Cao¹,

Zheng²,

Luo³

et al. 2020

Theranostics

View full text Add to dashboard Cite

show abstract

“…Complex interactions through direct cardiomyocyte invasion and indirect inflammatory-mediated damage could explain cardiac involvement in COVID-19 [21]. Myocardial injuries have been described in various case reports, from acute myocarditis to pseudo acute myocardial infarction [1][2][3][4]22], and several studies highlight an association between cardiac injuries and mortality [23][24][25][26]. Other studies suggested that abnormal heart rhythms are common [7,13,27].…”

Section: Discussionmentioning

confidence: 99%

Electrocardiographic abnormalities in COVID-19 patients visiting the emergency department: a multicenter retrospective study

Carvalho¹,

Leonard-Pons

Segard

et al. 2021

BMC Emerg Med

View full text Add to dashboard Cite

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be associated with myocardial injury. Identification of at-risk patients and mechanisms underlying cardiac involvement in COVID-19 remains unclear. During hospitalization for COVID-19, high troponin level has been found to be an independent variable associated with in-hospital mortality and a greater risk of complications. Electrocardiographic (ECG) abnormalities could be a useful tool to identify patients at risk of poor prognostic. The aim of our study was to assess if specific ECGs patterns could be related with in-hospital mortality in COVID-19 patients presenting to the ED in a European country. Methods From February 1st to May 31st, 2020, we conducted a multicenter study in three hospitals in France. We included adult patients (≥ 18 years old) who visited the ED during the study period, with ECG performed at ED admission and diagnosed with COVID-19. Demographic, comorbidities, drug exposures, signs and symptoms presented, and outcome data were extracted from electronic medical records using a standardized data collection form. The relationship between ECG abnormalities and in-hospital mortality was assessed using univariate and multivariable logistic regression analyses. Results An ECG was performed on 275 patients who presented to the ED. Most of the ECGs were in normal sinus rhythm (87%), and 26 (10%) patients had atrial fibrillation/flutter on ECG at ED admission. Repolarization abnormalities represented the most common findings reported in the population (40%), with negative T waves representing 21% of all abnormalities. We found that abnormal axis (adjusted odds ratio: 3.9 [95% CI, 1.1–11.5], p = 0.02), and left bundle branch block (adjusted odds ratio: 7.1 [95% CI, 1.9–25.1], p = 0.002) were significantly associated with in-hospital mortality. Conclusions ECG performed at ED admission may be useful to predict death in COVID-19 patients. Our data suggest that the presence of abnormal axis and left bundle branch block on ECG indicated a higher risk of in-hospital mortality in COVID-19 patients who presented to the ED. We also confirmed that ST segment elevation was rare in COVID-19 patients.

show abstract

“…Emergency units have been early reassessed to identify infected patients and select cases deserving hospitalization or more intensive cares [ 9 ]. Indeed, emergency physicians promptly published their experiences to share the weakness and strength of local organization, with the aim to facilitate other colleagues in different countries [ 10 ]. In accordance with our analysis, a recent bibliometric study also highlighted that the effects of COVID-19 on the healthcare system were the most studied topic (222/481, 46.1%) [ 11 ].…”

mentioning

confidence: 99%

Impact of COVID-19 in emergency medicine literature: a bibliometric analysis

et al. 2022

Self Cite

View full text Add to dashboard Cite

Complicated myocardial infarction in a 99-year-old lady in the era of COVID-19 pandemic: from the need to rule out coronavirus infection to emergency percutaneous coronary angioplasty

Abstract: a 99-year-old woman with hypertension and a previous history of coronary artery disease treated with coronary angioplasty and stent in the proximal left anterior descending coronary artery was admitted to the

Cited by 6 publications

References 14 publications

Myocardial injury and COVID-19: Serum hs-cTnI level in risk stratification and the prediction of 30-day fatality in COVID-19 patients with no prior cardiovascular disease

Myocardial injury and COVID-19: Serum hs-cTnI level in risk stratification and the prediction of 30-day fatality in COVID-19 patients with no prior cardiovascular disease

Electrocardiographic abnormalities in COVID-19 patients visiting the emergency department: a multicenter retrospective study

Impact of COVID-19 in emergency medicine literature: a bibliometric analysis

Contact Info

Product

Resources

About