Non-Obstructive Coronary Artery Disease due to COVID-19 Infection: St-Segment Elevation due to Endothelial Dysfunction

Abstract

The ongoing inflammatory process in COVID infection is reported to cause acute cardiac injury either due to direct cytotoxicity or oxidative stress injury to myocytes. Hypercoagulability and endothelial dysfunction are the two main events resulting in the transient thrombotic process. Objective: To assess the coronary artery occlusion in COVID infected patients presenting with ST-elevation myocardial injury. Methods: A descriptive case series study was conducted on 52 patients presenting with ST-elevation myocardial infarction along with COVID infection. Data was collected regarding demographic profile, Troponin levels, COVID PCR, changes in ECG, Echocardiographic findings and coronary arteries were assessed angiographically. Data were analyzed using SPSS software and various percentages were calculated. Results: Of all the 52 patients studied, 46 patients (88%) tested positive for COVID -19 on RT-PCR done via nasopharyngeal swab. Other 6 patients tested negative initially but they had findings on their CXR and HRCT suggestive of interstitial pneumonia. All the patients were in age group 30-60 years with 32 patients (62%) being males and 20 being females (38%). None of the patients previously had any history of angina or myocardial infarction. Inflammatory markers were raised in about 43 patients (82.7%). ECG showed ST segment elevation in anterior leads in 35 patients (67%) and in inferior leads in 9 patients (17%) and in lateral leads in 2 patients (3.8%). Qualitative Troponin I test was positive in all the patients, whereas, about 41 patients (78%) had Quantitative Troponin I test in high probability range. About 50 patients (96%) had Ejection Fraction greater than 45% and normal segmental wall motion analysis. The coronary arteries were reported to be normal or recanalized in 40 patients (76%) and mild-moderate disease in single or two vessels are present in rest of the 12 patients. None of the patients had shown culprit artery severe disease or clot burden on angiograms. Conclusions: Acute Cardiac injury in previously asymptomatic patients may be related to the pro-thrombotic state created by COVID-19 infection resulting in endothelial dysfunction and mimicking ST-elevation myocardial injury raising Troponin levels indicated by raised D-Dimers and CRP level. The auto-recanalization of the coronary arteries and normal echocardiographic findings, are good prognostic factors for the post cardiac injury rehabilitation.