Impact of SARS-CoV-2 positivity on clinical outcome among STEMI patients undergoing mechanical reperfusion: Insights from the ISACS STEMI COVID 19 registry.

Abstract

BACKGROUND AND AIMS:

SARS-Cov-2 predisposes patients to thrombotic complications, due to excessive inflammation, endothelial dysfunction, platelet activation, and coagulation/fibrinolysis disturbances. The aim of the present study was to evaluate clinical characteristics and prognostic impact of SARS-CoV-2 positivity among STEMI patients undergoing primary percutaneous coronary intervention (PPCI).

METHODS:

We selected SARS-CoV-2 positive patients included in the ISACS-STEMI COVID-19, a retrospective multicenter European registry including 6609 STEMI patients treated with PPCI from March 1st until April 30th, in 2019 and 2020. As a reference group, we randomly sampled 5 SARS-Cov-2 negative patients per each SARS-CoV-2 positive patient, individually matched for age, sex, and hospital/geographic area. Study endpoints were in-hospital mortality, definite stent thrombosis, heart failure.

RESULTS:

Our population is represented by 62 positive SARS-CoV-2 positive patients who were compared with a matched population of 310 STEMI patients. No significant difference was observed in baseline characteristics or the modality of access to the PCI center. In the SARS-CoV-2 positive patients, the culprit lesion was more often located in the RCA (p < 0.001). Despite similar pre and postprocedural TIMI flow, we observed a trend in higher use of GP IIb-IIIa inhibitors and a significantly higher use of thrombectomy in the SARS-CoV-2 positive patients. SARS-CoV-2 positivity was associated with a remarkably higher in hospital mortality (29% vs 5.5%, p < 0.001), definite in-stent thrombosis (8.1% vs 1.6%, p = 0.004) and heart failure (22.6% vs 10.6%, p = 0.001) that was confirmed after adjustment for confounding factors.

CONCLUSIONS:

Our study showed that among STEMI patients, SARS-CoV-2 positivity is associated with larger thrombus burden, a remarkably higher mortality but also higher rates of in-stent thrombosis and heart failure.

• Authors: Giuseppe De Luca, Niels Debel, Miha Cercek, Lisette Okkels Jensen, Marija Vavlukis, Lucian Calmac, Tom Johnson, Gerard Rourai Ferrer, Vladimir Ganyukov, Wojtek Wojakowski, Tim Kinnaird, Clemens von Birgelen, Yves Cottin, Alexander IJsselmuiden, Bernardo Tuccillo, Francesco Versaci, Kees-Jan Royaards, Jurrien Ten Berg, Mika Laine, Maurits Dirksen, Massimo Siviglia, Gianni Casella, Petr Kala, José Luis Díez Gil, Adrian Banning, Victor Becerra, Ciro De Simone, Andrea Santucci, Xavier Carrillo, Alessandra Scoccia, Giovanni Amoroso, Arnoud Wj Van't Hof, Tomas Kovarnik, Grigorios Tsigkas, Julinda Mehilli, Gabriele Gabrielli, Xacobe Flores Rios, Nikola Bakraceski, Sébastien Levesque, Giuseppe Cirrincione, Vincenzo Guiducci, Michał Kidawa, Leonardo Spedicato, Lucia Marinucci, Peter Ludman, Filippo Zilio, Gennaro Galasso, Enrico Fabris, Maurizio Menichelli, Arturo Garcia-Touchard, Stephane Manzo, Gianluca Caiazzo, Jose Moreu, Juan Sanchis Forés, Luca Donazzan, Luigi Vignali, Rui Teles, Edouard Benit, Pierfrancesco Agostoni, Francisco Bosa Ojeda, Heidi Lehtola, Santiago Camacho-Freiere, Adriaan Kraaijeveld, Ylitalo Antti, Marco Boccalatte, Pierre Deharo, Iñigo Lozano Martínez-Luengas, Bruno Scheller, Efthymia Varytimiadi, Raul Moreno, Giuseppe Uccello, Benjamin Faurie, Alejandro Gutierrez Barrios, Marek Milewski, Ewout Bruwiere, Pieter Smits, Bor Wilbert, Fortunato Scotto Di Uccio, Guido Parodi, Elvin Kedhi, Monica Verdoia
• Journal: Atherosclerosis (Atherosclerosis) Vol. 332 Pg. 48-54 (09 2021) ISSN: 1879-1484 [Electronic] Ireland
• PMID: 34391035 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 Elsevier B.V. All rights reserved.

Topics

• COVID-19
• Humans
• Percutaneous Coronary Intervention (adverse effects)
• Registries
• Reperfusion
• Retrospective Studies
• SARS-CoV-2
• ST Elevation Myocardial Infarction (diagnosis, surgery)
• Treatment Outcome