There may be a strong signal towards higher thrombus burden and poorer outcomes in COVID-19 patients presenting with STEMI, supporting the need for establishing COVID-19 status in all STEMI cases, according to a study published July 14 in the Journal of the American College of Cardiology.

In this single-center, observational study, Fizzah A. Choudry, PhD, et al., assessed 115 consecutive STEMI patients with and without COVID-19 infection treated with PCI. Researchers compared their baseline characteristics, angiographic, procedural and clinical outcomes to STEMI patients who were COVID-negative.

Results showed that STEMI patients 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 was also found to be 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.

In addition, researchers found that myocardial blush grade and left ventricular function were significantly lower in COVID-19 patients with STEMI. Higher doses of heparin to achieve therapeutic activated clotting times were also noted.

Importantly, the researchers add that STEMI patients presenting with COVID-19 infection had a longer in-patient admission and higher rates of intensive care admission.

"The strong signal towards significantly higher thrombus burden is a novel finding that raises the question of more aggressive anti-thrombotic therapy in selected COVID STEMI cases and provides a rationale for establishing COVID status in all STEMI cases," the researchers conclude. "Further work is required to unravel the underlying mechanism of coronary thrombosis in patients with COVID-19 infection."

Clinical Topics: Anticoagulation Management, COVID-19 Hub, Invasive Cardiovascular Angiography and Intervention, Stable Ischemic Heart Disease, Vascular Medicine, Interventions and Vascular Medicine, Chronic Angina

Keywords: Coronary Thrombosis, ST Elevation Myocardial Infarction, Troponin T, Heparin, COVID-19, Patient Admission, Ventricular Function, Left, Percutaneous Coronary Intervention, severe acute respiratory syndrome coronavirus 2, Thrombocytopenia, Myocardium, Cardiology

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