Characteristics and Outcomes in Patients Presenting With COVID-19 and ST-Segment Elevation Myocardial Infarction

Am J Cardiol. 2020 Sep 15;131:1-6. doi: 10.1016/j.amjcard.2020.06.063. Epub 2020 Jul 3.

Abstract

There is limited information regarding clinical characteristics and outcomes of patients with SARS-CoV-2 (COVID-19) disease presenting with ST-segment elevation myocardial infarction (STEMI). In this multicenter retrospective study, we reviewed charts of patients admitted with symptomatic COVID-19 infection and STEMI to a total of 4 hospitals spanning Italy, Lithuania, Spain and Iraq from February 1, 2020 to April 15, 2020. A total of 78 patients were included in this study, 49 (63%) of whom were men, with a median age of 65 [58, 71] years, and high comorbidity burden. During hospitalization, 8 (10%) developed acute respiratory distress syndrome, and 14 (18%) required mechanical ventilation. 19 (24%) patients were treated with primary Percutaneous Coronary Intervention (PCI) and 59 (76%) were treated with fibrinolytic therapy. 13 (17%) patients required cardiac resuscitation, and 9 (11%) died. For the 19 patients treated with primary PCI, 8 (42%) required intubation and 8 (42%) required cardiac resuscitation; stent thrombosis occurred in 4 patients (21%). A total of 5 patients (26%) died during hospitalization. 50 (85%) of the 59 patients initially treated with fibrinolytic therapy had successful fibrinolysis. The median time to reperfusion was 27 minutes [20, 34]. Hemorrhagic stroke occurred in 5 patients (9%). Six patients (10%) required invasive mechanical ventilation; 5 (9%) required cardiac resuscitation, and 4 (7%) died. In conclusion, this is the largest case series to-date of COVID-19 positive patients presenting with STEMI and spans 4 countries. We found a high rate of stent thrombosis, indicating a possible need to adapt STEMI management for COVID-19 patients.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Betacoronavirus*
  • COVID-19
  • Coronary Angiography
  • Coronavirus Infections / complications*
  • Coronavirus Infections / epidemiology
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Follow-Up Studies
  • Humans
  • Incidence
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Pandemics
  • Percutaneous Coronary Intervention / methods*
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / epidemiology
  • Retrospective Studies
  • SARS-CoV-2
  • ST Elevation Myocardial Infarction / complications
  • ST Elevation Myocardial Infarction / diagnosis
  • ST Elevation Myocardial Infarction / therapy*
  • Spain / epidemiology
  • Survival Rate / trends
  • Thrombolytic Therapy / methods*
  • Treatment Outcome

Substances

  • Fibrinolytic Agents