Patients with coronavirus disease 2019 (COVID-19) who also have ST-segment elevation myocardial infarction (STEMI) may experience greater thrombus burden and need for intensive care, and longer hospital stays, according to a study published in the Journal of the American College of Cardiology.
In this observational study, the data of 115 consecutive patients (median age, 62 years; 33.9% with COVID-19) who were admitted to a heart center in London, United Kingdom, between January, 3 and May, 20 2020 with confirmed STEM were examined. STEMI was treated with primary percutaneous coronary intervention (PCI). The study’s primary endpoint was all-cause in-hospital mortality; secondary endpoints were thrombus burden, Thrombolysis in Myocardial Infarction (TIMI) flow, myocardial blush grade, length of hospitalization, and the need for intensive care unit (ICU) admission.
Patients with vs without concurrent COVID-19 were found to be more likely to have diabetes (46% vs 26%, respectively; P =.038), hypertension (72% vs 42%, respectively; P =.003), hyperlipidemia (62% vs 37%, respectively; P =.038), cardiac arrest (28% vs 9%, respectively; P =.0013), and to have had prior PCI (23% vs 7%, respectively; P =.016).
In addition, patients with STEMI and with vs without COVID-19 had greater levels of high-sensitivity troponin (1221 ng/L vs 369 ng/L, respectively; P =.0028), D-dimer (1.86 mg/L vs 0.52 mg/L, respectively; P =.0012), and C-reactive protein (12 mg/L vs 50 mg/L, respectively; P =.01), and lower lymphocyte counts (1.3.109/L vs 1.7.109/L, respectively; P =.0002).
Higher thrombogenicity was also observed in the group of patients with vs without COVID-19, including higher rates of multi-vessel thrombosis (P =.0003) and stent thrombosis (P =.04). Patients with vs without COVID-19 also had a higher modified thrombus grade after first device in patients with thrombus grade 5 (modified thrombus grade 4/5: 75% vs 31%, respectively; P =.0006), greater use of GP IIb/IIIa inhibitors and aspiration thrombectomy (P <.0001 and P =.0021, respectively), longer hospital stays (P =.0004) and were more likely to require ICU admission (P =.003).
Limitations of this study include its retrospective and observational nature, single-center design, and small cohort.
“The strong signal towards significantly higher thrombus burden is a novel finding that raises the question of more aggressive anti-thrombotic therapy in selected COVID STEMI cases and provides a rationale for establishing COVID status in all STEMI cases,” concluded the study authors.
Choudry FA, Hamshere SM, Rathod KS, et al. High thrombus burden in patients with COVID-19 presenting with ST-elevation myocardial infarction [published online July 10, 2020]. J Am Coll Cardiol. doi:10.1016/j.jacc.2020.07.022