ST-segment elevation in patients with COVID-19: a systematic review

Abstract

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.

STEMI care 2021: Addressing the knowledge gaps

“…A systemic review of case reports and case series reported a relatively higher incidence of non-obstructive lesions (17%) in STEMI patients with concurrent Covid-19 infection. In-hospital mortality was also relatively high (30%), without a significant difference between obstructive and non-obstructive lesions [48] . The recently published NACMI registry, established in North America with a collaboration of multinational societies, provided a more comprehensive view [49] .…”

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“…The quantitative content assessment was performed using Murad's tool for evaluating the methodological quality of case reports and case series, which is a modified version of the Newcastle–Ottawa Scale [ 17 ]. This scale has been used recently in systematic reviews of case reports and case series [ 18 – 21 ]. The tool has five questions with dichotomic answers.…”

Emerging Role of Platelet-Endothelium Interactions in the Pathogenesis of Severe SARS-CoV-2 Infection-Associated Myocardial Injury

“…The second study showed a significant increase in in-hospital mortality, stent thrombosis and cardiogenic shock after percutaneous revascularization in those patients with STEMI and COVID-19 infection compared with a contemporaneous group of non-COVID STEMI patients (55). The third study indicated that STEMI patients admitted during the first wave of COVID-19 infections in Israel, had a longer ischemic time, which translated into more severe disease on hospital admission and a higher in-hospital adverse event rate than observed in STEMI cases admitted in a corresponding period in 2018 (57).…”

“…Interestingly a literature review of COVID-19 patients who had STEMI, in the early part of the pandemic, documented that 17% of cases were due to non-obstructive coronary artery disease, which was associated with a mortality of 30% (similar to those with obstructive coronary artery disease); however, such data were based on case reports and case series only (57). The role of thrombosis, including extensive and multi-vessel thrombosis, irrespective of the presence or absence of atherosclerotic plaques has been described, and is reviewed elsewhere (58,59).…”