ST-Elevation Myocardial Infarction in Patients With COVID-19
Giulio Stefanini, Matteo Montorfano, Daniela Trabattoni, Daniele Andreini, Giuseppe Ferrante, Marco Ancona, Marco Metra, Salvatore Curello, Diego Maffeo, Gaetano Pero, Michele Cacucci, Emilio Assanelli, Bárbara Bellini, Filippo Russo, Alfonso Ielasi, Maurizio Tespili, Gian Battista Danzi, Pietro Vandoni, Mario Bollati, Lucia Barbieri, Jacopo Oreglia, Corrado Lettieri, Alberto Cremonesi, Stefano Carugo, Bernhard Reimers, Gianluigi Condorelli, Alaide Chieffo
Abstract
oronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is causing a dramatic pandemic. 1ombardy, in northern Italy, is one of the most affected regions worldwide. 2ardiovascular complications occur frequently in patients with COVID-19, 3 with challenges in acute management.We aimed to evaluate incidence, clinical presentation, angiographic findings, and clinical outcomes of ST-elevation myocardial infarction (STEMI) in patients with COVID-19.All hospitals with catherization laboratories in Lombardy were contacted to collect cases of patients with confirmed COVID-19 who underwent an urgent coronary angiogram because of STEMI between February 20, 2020 (date of first COVID-19 case in Lombardy) and March 30, 2020. 2 Data were collected retrospectively, in anonymized fashion without any sensitive data, therefore not requiring institutional review board approval.COVID-19 was confirmed with reverse transcription-polymerase chain reaction assays.STEMI was defined based on the presence of typical symptoms associated with ST-segment elevation or new left bundle-branch block. 4A stenosis was considered as the culprit lesion in case of angiographic evidence of thrombotic occlusion/subocclusion.Obstructive coronary artery disease was defined based on the angiographic evidence of a stenosis >50% on visual estimation.A total of 28 patients with COVID-19 with STEMI were included.All patients met the guideline definition of STEMI 4 with localized ST-elevation (25 patients, 89.3%) or new left bundle-branch block (3 patients, 10.7%), and all were treated in the setting of emergent activation.The Table displays a detailed overview of each included patient.The mean age was 68±11 years, 8 patients (28.6%) were women, 20 (71.4%) had arterial hypertension, 9 (32.1%) had diabetes mellitus, 8 (28.6%) had chronic kidney disease, and 3 (10.7%)had a previous myocardial infarction.For 24 patients (85.7%), the STEMI represented the first clinical manifestation of COVID-19, and they did not have a COVID-19 test result at the time of coronary angiography.The remaining 4 patients had STEMI during hospitalization for COVID-19.Twenty-two patients (78.6%) presented with typical chest pain associated with or not associated with dyspnea, and 6 patients (21.4%) had dyspnea without chest pain.On echocardiography, 23 patients (82.1%) had localized wall motion abnormalities, 3 (10.7%)had diffuse hypokinesia, and 2 (7.1%) did not have abnormalities.The left ventricular ejection fraction was <50% in 17 patients (60.7%).All patients underwent urgent coronary angiography, and none was treated with fibrinolysis.Out of 28 patients, 17 patients (60.7%) had evidence of a culprit lesion requiring revascularization, and 11 patients (39.3%) did not have obstructive coronary artery disease.