High Thrombus Burden in Patients With COVID-19 Presenting With ST-Segment Elevation Myocardial Infarction

J Am Coll Cardiol. 2020 Sep 8;76(10):1168-1176. doi: 10.1016/j.jacc.2020.07.022. Epub 2020 Jul 14.


Background: Coronavirus disease-2019 (COVID-19) is thought to predispose patients to thrombotic disease. To date there are few reports of ST-segment elevation myocardial infarction (STEMI) caused by type 1 myocardial infarction in patients with COVID-19.

Objectives: The aim of this study was to describe the demographic, angiographic, and procedural characteristics alongside clinical outcomes of consecutive cases of COVID-19-positive patients with STEMI compared with COVID-19-negative patients.

Methods: This was a single-center, observational study of 115 consecutive patients admitted with confirmed STEMI treated with primary percutaneous coronary intervention at Barts Heart Centre between March 1, 2020, and May 20, 2020.

Results: Patients with STEMI presenting with concurrent COVID-19 infection had higher levels of troponin T and lower lymphocyte count, but elevated D-dimer and C-reactive protein. There were significantly higher rates of multivessel thrombosis, stent thrombosis, higher modified thrombus grade post first device with consequently higher use of glycoprotein IIb/IIIa inhibitors and thrombus aspiration. Myocardial blush grade and left ventricular function were significantly lower in patients with COVID-19 with STEMI. Higher doses of heparin to achieve therapeutic activated clotting times were also noted. Importantly, patients with STEMI presenting with COVID-19 infection had a longer in-patient admission and higher rates of intensive care admission.

Conclusions: In patients presenting with STEMI and concurrent COVID-19 infection, there is a strong signal toward higher thrombus burden and poorer outcomes. This supports the need for establishing COVID-19 status in all STEMI cases. Further work is required to understand the mechanism of increased thrombosis and the benefit of aggressive antithrombotic therapy in selected cases.

Keywords: COVID-19; ST-segment elevation myocardial infarction; primary percutaneous coronary intervention; thrombosis.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Betacoronavirus / isolation & purification
  • C-Reactive Protein / analysis
  • COVID-19
  • Comorbidity
  • Coronary Angiography / methods
  • Coronary Thrombosis* / blood
  • Coronary Thrombosis* / diagnosis
  • Coronary Thrombosis* / etiology
  • Coronavirus Infections* / blood
  • Coronavirus Infections* / complications
  • Coronavirus Infections* / diagnosis
  • Coronavirus Infections* / epidemiology
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • Fibrinolytic Agents / therapeutic use*
  • Humans
  • Lymphocyte Count / methods
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Pandemics*
  • Patient Selection
  • Percutaneous Coronary Intervention / methods*
  • Pneumonia, Viral* / blood
  • Pneumonia, Viral* / complications
  • Pneumonia, Viral* / diagnosis
  • Pneumonia, Viral* / epidemiology
  • SARS-CoV-2
  • ST Elevation Myocardial Infarction* / epidemiology
  • ST Elevation Myocardial Infarction* / therapy
  • Severity of Illness Index
  • Troponin T / blood


  • Fibrin Fibrinogen Degradation Products
  • Fibrinolytic Agents
  • Troponin T
  • fibrin fragment D
  • C-Reactive Protein