Angiographic characteristics of patients with STEMI and COVID-19: Insights from NACMI registry.
Am Heart J
; 271: 112-122, 2024 05.
Article
in En
| MEDLINE
| ID: mdl-38395293
ABSTRACT
BACKGROUND:
To date, there has been no independent core lab angiographic analysis of patients with COVID-19 and STEMI. The study characterized the angiographic parameters of patients with COVID-19 and STEMI.METHODS:
Angiograms of patients with COVID-19 and STEMI from the North American COVID-19 Myocardial Infarction (NACMI) Registry were sent to a Core Laboratory in Vancouver, Canada. Culprit lesion(s), Thrombolysis In Myocardial Infarction (TIMI) flow, Thrombus Grade Burden (TGB), and percutaneous coronary intervention (PCI) outcome were assessed.RESULTS:
From 234 patients, 74% had one culprit lesion, 14% had multiple culprits and 12% had no culprit identified. Multivessel thrombotic disease and multivessel CAD were found in 27% and 53% of patients, respectively. Stent thrombosis accounted for 12% of the presentations and occurred in 55% of patients with previous coronary stents. Of the 182 who underwent PCI, 60 (33%) had unsuccessful PCI due to post-PCI TIMI flow <3 (43/60), residual high thrombus burden (41/60) and/or thrombus related complications (27/60). In-hospital mortality for successful, partially successful, and unsuccessful PCI was 14%, 13%, and 27%, respectively. Unsuccessful PCI was associated with increased risk of in-hospital mortality (risk ratio [RR] 1.96; 95% CI 1.05-3.66, P = .03); in the adjusted model this estimate was attenuated (RR 1.24; 95% CI 0.65-2.34, P = .51).CONCLUSION:
In patients with COVID-19 and STEMI, thrombus burden was pervasive with notable rates of multivessel thrombotic disease and stent thrombosis. Post-PCI, persistent thrombus and sub-optimal TIMI 3 flow rates led to one-third of the PCI's being unsuccessful, which decreased over time but remained an important predictor of in-hospital mortality.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Registries
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Coronary Angiography
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Percutaneous Coronary Intervention
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ST Elevation Myocardial Infarction
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COVID-19
Limits:
Aged
/
Female
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Humans
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Male
/
Middle aged
Country/Region as subject:
America do norte
Language:
En
Journal:
Am Heart J
Year:
2024
Type:
Article