The Challenge of High Coronary Thrombotic Events in Patients with ST-Segment Elevation Myocardial Infarction and COVID-19

Abstract

The aim of this observational study was to describe the characteristics and outcomes of coronavirus disease 2019 (COVID-19)-positive patients with ST-segment elevation myocardial infarction (STEMI), with a special focus on factors associated with a high risk of coronary thrombosis and in-hospital mortality. Comparing the two groups of patients with STEMI separated according to the presence of SARS-CoV-2 infections, it was observed that COVID-19 patients were more likely to present with dyspnea (82.43% vs. 61.41%, p = 0.048) and cardiogenic shock (10.52% vs. 5.40%, p = 0.012). A longer total ischemia time was observed in COVID-19 patients, and they were twice as likely to undergo coronary angiography more than 12 hours after the onset of symptoms (19.29% vs. 10.13%, p = 0.024). In 10 of 57 COVID-19-positive patients, a primary PCI was not necessary, and only thromboaspiration was performed (17.54% vs. 2.70%, p < 0.001). Platelet level was inversely correlated (r = −0.512, p = 0.025) with a higher risk of coronary thrombosis without an atherosclerotic lesion. Using a cut-off value of 740 ng/ml, D-dimers predicted a higher risk of coronary thrombosis, with a sensitivity of 80% and a specificity of 66% (ROC area under the curve: 0.826, 95% CI: 0.716–0.935, p = 0.001). These are novel findings that raise the question of whether more aggressive antithrombotic therapy is necessary for selected COVID-19 and STEMI patients.

Electrocardiogram Features in Non-Cardiac Diseases: From Mechanisms to Practical Aspects

“…Other possible explanations for the myriad of cardiac arrhythmias related to COVID-19 lie in the myocardial stress caused by metabolic and electrolyte abnormalities, as well as inflammation of cardiomyocytes, increased catecholamine release, and effects of hypoxia. 188 …”

“…Other possible explanations for the myriad of cardiac arrhythmias related to COVID-19 lie in the myocardial stress caused by metabolic and electrolyte abnormalities, as well as inflammation of cardiomyocytes, increased catecholamine release, and effects of hypoxia. 188 Increased QT interval longer than 120 ms is considered one of the major ECG changes in COVID-19. One of the explanations for QT prolongation in patients with COVID-19 points towards the systemic inflammation that widens QTc via cytokine-mediated effects on potassium channel expression, followed suit by prolongation of the action potential leading to increased QTc interval.…”

The Significance of Low Magnesium Levels in COVID-19 Patients

“…Coronary artery disease and hypertension are common coexisting disorders in patients with COVID-19 [ 85 , 135 ]. The affinity of the SAR-CoV-2 virus for the ACE-2 receptor has been proposed to be the core of the pathophysiology of the disease.…”

Distinct Features of Vascular Diseases in COVID-19

“…Therefore, many CAD patients were exposed to an increased risk of coronary events. 83 , 84 Clinical data showed that although hospital admissions for acute myocardial infarction decreased since the COVID-19 outbreak, the cases were more severe. Indeed, higher troponin levels, increased mortality rate, major cardiac complications, and delays from symptoms onset to first medical contact were noticed.…”