Author + information
- Fizzah A. Choudry, PhD1,2,
- Stephen M. Hamshere, MD1,2,
- Krishnaraj S. Rathod, PhD1,2,
- Mohammad M. Akhtar, MD1,2,
- R Andrew Archbold, MD1,
- Oliver P. Guttmann, MD1,2,
- Simon Woldman, MD1,2,
- Ajay K. Jain, MD1,2,
- Charles J. Knight, MD1,2,
- Andreas Baumbach, MD1,2,
- Anthony Mathur, PhD1,2 and
- Daniel A. Jones, PhD1,2,∗ (, )@bhcintervention
- 1Department of Cardiology, Barts Heart Centre, St Bartholomew’s Hospital
- 2Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London
- ↵∗Address for correspondence Dr. Daniel A Jones Senior Lecturer and Honorary Consultant Cardiologist Barts Heart Centre West Smithfield London EC1A 7BE Tel no: ++442037658707 Fax no: ++442034656483.,.
Background Coronavirus disease 2019 (COVID-19) is thought to predispose patients to thrombotic disease. To date there are few reports of ST-elevation myocardial infarction (STEMI) caused by type 1 myocardial infarction in COVID-19 patients.
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 STEMI patients compared to COVID-19 negative patients.
Methods This was a single-centre, observational study of 115 consecutive patients admitted with confirmed STEMI treated with primary percutaneous coronary intervention at Barts Heart Centre between 01/03/2020 and 20/05/2020.
Results STEMI patients presenting with concurrent COVID-19 infection had higher levels of Troponin T, lower lymphocyte count, but elevated D-dimer and C-reactive protein. There was significantly higher rates of multi-vessel thrombosis, stent thrombosis, higher modified thrombus grade post first device with consequently higher use of GP IIb/IIIa inhibitors and thrombus aspiration. Myocardial blush grade and left ventricular function were significantly lower in COVID patients with STEMI. Higher doses of heparin to achieve therapeutic ACTs were also noted. Importantly, STEMI patients 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 towards higher thrombus burden and poorer outcomes. This supports the need for establishing COVID status in all STEMI cases. Further work is required to understand the mechanism of increased thrombosis and the benefit of aggressive anti-thrombotic therapy in selected cases.
Disclosure Statement: All authors have no conflicts of interest, nothing to disclose.
- Received June 29, 2020.
- Revision received July 6, 2020.
- Accepted July 7, 2020.