ST-Segment Elevation in Patients With COVID-19

Study Questions:

What was the experience with ST-segment elevation in the initial month of the COVID-19 outbreak in New York City?

Methods:

The investigators included patients with confirmed COVID-19 who had ST-segment elevation on electrocardiography from six New York hospitals in this case series. Patients with COVID-19 who had nonobstructive disease on coronary angiography or had normal wall motion on echocardiography in the absence of angiography were presumed to have noncoronary myocardial injury.

Results:

The investigators identified 18 patients with COVID-19 who had ST-segment elevation indicating potential acute myocardial infarction. The median age of the patients was 63 years, 83% were men, and 33% had chest pain around the time of ST-segment elevation. A total of 10 patients (56%) had ST-segment elevation at the time of presentation, and the other eight patients had development of ST-segment elevation during hospitalization (median, 6 days). A total of nine patients (50%) underwent coronary angiography; six of these patients (67%) had obstructive disease, and five (56%) underwent percutaneous coronary intervention (one after the administration of fibrinolytic agents). A total of 13 patients (72%) died in the hospital (four patients with myocardial infarction and nine with noncoronary myocardial injury).

Conclusions:

The authors concluded that in this series of patients with COVID-19 who had ST-segment elevation, there was variability in presentation, a high prevalence of nonobstructive disease, and a poor prognosis.

Perspective:

This case series reports that among patients with COVID-19 who had STEMI, there was variability in presentation, a high prevalence of nonobstructive disease, and a poor prognosis. Only one half of the patients underwent coronary angiography, of whom two thirds had obstructive disease. Of note, all patients had elevated D-dimer levels in this series compared to a previous study involving patients with STEMI where 64% had normal D-dimer levels. Myocardial injury in patients with COVID-19 could be due to a multitude of causes including plaque rupture, cytokine storm, hypoxic injury, coronary spasm, microthrombi, or direct endothelial or vascular injury. Dedicated studies are indicated to assess optimal therapies for myocardial injury in COVID-19 patients to improve outcomes.

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Vascular Medicine, Interventions and ACS, Interventions and Imaging, Interventions and Vascular Medicine, Angiography, Echocardiography/Ultrasound, Nuclear Imaging

Keywords: Acute Coronary Syndrome, Chest Pain, Coronary Angiography, COVID-19, Coronavirus, Cytokines, Diagnostic Imaging, Echocardiography, Electrocardiography, Fibrinolytic Agents, Myocardial Infarction, Primary Prevention, Percutaneous Coronary Intervention, Secondary Prevention, severe acute respiratory syndrome coronavirus 2, Vascular System Injuries


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