Abstract
Data regarding angiographic characteristics, clinical profile, and inhospital outcomes of patients with coronavirus disease 2019 (COVID-19) referred for coronary angiography (CAG) are scarce. This is an observational study analyzing confirmed patients with COVID-19 referred for CAG from 10 European centers. We included 57 patients (mean age: 66 ± 15 years, 82% male) , of whom 18% had previous myocardial infarction (MI) and 29% had renal insufficiency and chronic pulmonary disease. ST-segment elevation myocardial infarction (STEMI) was the most frequent indication for CAG (58%). Coronavirus disease 2019 was confirmed after CAG in 86% and classified as mild in 49%, with 21% fully asymptomatic. A culprit lesion was identified in 79% and high thrombus burden in 42%; 7% had stent thrombosis. At 40 days follow-up, 16 (28%) patients experienced a major adverse cardiovascular event (MACE): 12 deaths (92% noncardiac), 1 MI, 2 stent thrombosis, and 1 stroke. In an European multicenter registry, patients with confirmed COVID-19 infection referred for CAG during the first wave of the severe acute respiratory syndrome coronavirus 2 pandemic presented mostly with STEMI and were predominantly males with comorbidities. Severity of COVID-19 was in general noncritical and 21% were asymptomatic at the time of CAG. Culprit coronary lesions with high thrombus burden were frequently identified, with a rate of stent thrombosis of 7%. The incidence of MACE at 40 days was high (28%), mostly due to noncardiac death.
Highlights
The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) has led to the onset of a new disease denominated coronavirus disease 2019 (COVID-19)
We aimed to describe the clinical and angiographic characteristics, related to each particular clinical context, in a cohort of confirmed patients with COVID-19 referred for invasive coronary angiography (CAG) in 9 different centers in 2 European countries
A total of 57 patients with PCR-confirmed COVID-19 referred for invasive CAG during the study period and were included in the registry
Summary
The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) has led to the onset of a new disease denominated coronavirus disease 2019 (COVID-19). Patients with suspected or confirmed COVID-19 may present with an acute coronary syndrome (ACS) as the first clinical manifestation of the disease, even in the absence of respiratory symptoms. The role of invasive coronary angiography (CAG) may be crucial in defining the underlying mechanism and establishing the subsequent treatment in patients with COVID-19 presenting with cardiac injury. The potentially associated risks for health care workers and the particular institutional logistics during the pandemic led to development of clinical algorithms to identify patients with COVID-19 who would benefit from an invasive strategy. Current recommendations advise restricting invasive CAG to patients with COVID-19 in whom type I MI is suspected.[7] lack of understanding of the pathophysiological mechanisms of cardiac injury, especially in early phases of the pandemic, resulted in a heterogeneous COVID19 population referred for CAG
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