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

• DOI: 10.1016/j.atherosclerosis.2021.06.926
• Publication Date: 2021-07-21T21:17:08Z
• Authors: Giuseppe De Luca; Niels Debel; Miha Cercek; Lisette Okkels Je...; Marija Vavlukis; Lucian Calmac; Tom Johnson; Gerard Rourai Ferrer; Vladimir Ganyukov; Wojtek Wojakowski; Tim Kinnaird; Clemens von Birgelen; Yves Cottin; Alexander IJsselm...; 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-Tou...; Stephane Manzo; Gianluca Caiazzo; Jose Moreu; Juan Sanchis Forés; Luca Donazzan; Luigi Vignali; Rui Teles; Edouard Benit; Pierfrancesco Ago...; Francisco Bosa Ojeda; Heidi Lehtola; Santiago Camacho-...; Adriaan Kraaijeveld; Ylitalo Antti; Marco Boccalatte; Pierre Deharo; Iñigo Lozano Mart...; Bruno Scheller; Efthymia Varytimiadi; Raul Moreno; Giuseppe Uccello; Benjamin Faurie; Alejandro Gutierr...; Marek Milewski; Ewout Bruwiere; Pieter Smits; Bor Wilbert; Fortunato Scotto ...; Guido Parodi; Elvin Kedhi; Monica Verdoia
• Keywords: Registrie; ST Elevation Myocardial Infarction/diagnosis; SARS-CoV-2; ST segment elevation myocardial infarction; Thrombosis(please add them); Humans; Registries; Reperfusion; Retrospective Studies; SARS-CoV-2; Treatment Outcome; COVID-19; Percutaneous Coronary Intervention; ST Elevation Myocardial Infarction; PRIMARY ANGIOPLASTY; 610; SARS-CoV-2; ST segment elevation myocardial infarction;; Article; 03 medical and health sciences; Percutaneous Coronary Intervention; 0302 clinical medicine; Retrospective Studie; 616; Humans; Registries; THROMBUS ASPIRATION; METAANALYSIS; Percutaneous Coronary Intervention/adverse effects; Thrombosis(please add them); Retrospective Studies; ST segment elevation myocardial infarction; SARS-CoV-2; MORTALITY; *ST segment elevation myocardial infarction; ELEVATION MYOCARDIAL-INFARCTION; COVID-19; *SARS-CoV-2; General medicine, internal medicine and other clinical medicine; 3. Good health; Treatment Outcome; Reperfusion; ST Elevation Myocardial Infarction; Cardiology and Cardiovascular Medicine; *Thrombosis(please add them); Human

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).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.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.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.