Abstract
BackgroundPatients with established cardiovascular diseases have a poor prognosis when affected by the coronavirus disease 2019 (COVID-19). Also, the cardiovascular system, especially the heart, is affected by COVID-19. So we aimed to evaluate the angiographic and clinical characteristics of COVID-19 patients presented by ST-elevation myocardial infarction (STEMI).ResultsOur retrospective study showed that STEMI patients with COVID-19 had elevated inflammatory markers with mean of their CRP (89.69 ± 30.42 mg/dl) and increased laboratory parameters of thrombosis with mean D-dimer (660.15 ± 360.11 ng/ml). In 69.2% of patients, STEMI was the first clinical presentation and symptoms suggestive of COVID-19 developed during the hospital stay; about one third of patients had a non-obstructive CAD, while patients with total occlusion had a high thrombus burden.ConclusionSTEMI may be the initial presentation of COVID-19. A non-obstructive CAD was found in about one third of patients; on the other hand, in patients who had a total occlusion of their culprit artery, the thrombus burden was high. Identification of the underlying mechanism responsible for the high thrombus burden in these patients is important as it may result in changes in their primary management strategy, either primary PCI, fibrinolytic therapy, or a pharmaco-invasive strategy. Furthermore, adjunctive anticoagulation and antiplatelet therapy may need to be revised.
Highlights
Patients with established cardiovascular diseases have a poor prognosis when affected by the coronavirus disease 2019 (COVID-19)
Aim of work In the current study, we aim to evaluate the angiographic and clinical characteristics of COVID-19 patients presented by ST-elevation myocardial infarction (STEMI)
Stefanini et al [20] evaluating the COVID-19 patients with STEMI in Lombardy, Italy, showed that 78.6% of patients presented with chest pain and 21.4% presented with dyspnea, while we showed that angina equivalent is the presenting symptom in 42.3% of patients
Summary
Patients with established cardiovascular diseases have a poor prognosis when affected by the coronavirus disease 2019 (COVID-19). Most of the coronavirus disease 2019 (COVID19) patients often have mild symptoms or may be asymptomatic, some patients may present with more serious symptoms, including pneumonia and acute respiratory distress syndrome. Patients with traditional cardiovascular risk factors like hypertension, diabetes, obesity, male sex, and those with established cardiovascular diseases are considered high-risk patients with increased mortality and morbidity when affected by COVID-19 [1, 2]. The cardiovascular system, especially the heart, is affected by the COVID-19. This affection could be through direct myocardial injury due to hypoxia, hemodynamic instability, thrombosis due to hypercoagulability, and myocarditis. The ACE2 is expressed in the vascular endothelium; the viremia could directly destabilize plaques and causing type 1
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