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

• Autoři: DE LUCA G.; DEBEL N.; CERCEK M.; JENSEN L. O.; VAVLUKIS M.; CALMAC L.; JOHNSON T.; FERRER G. R.; GANYUKOV V.; WOJAKOWSKI W.; KINNAIRD T .; VON BIRGELEN C.; COTTIN Y.; IJSSELMUIDEN A.; TUCCILLO B.; VERSACI F.; ROYAARDS K. J .; TEN BERG J.; LAINE M.; DIRKSEN M.; SIVIGLIA M.; CASELLA G.; KALA Petr; GIL J. L. D.; BANNING A.; BECERRA V .; DE SIMONE C.; SANTUCCI A.; CARRILLO X.; SCOCCIA A.; AMOROSO G.; VAN'T HOF A. W.; KOVARNIK T.; TSIGKAS G.; MEHILLI J.; GABRIELLI G.; RIOS X. F.; BAKRACESKI N.; LEVESQUE S.; CIRRINCIONE G.; GUIDUCCI V.; KIDAWA M.; SPEDICATO L.; MARINUCCI L.; LUDMAN P.; ZILIO F.; GALASSO G.; FABRIS E.; MENICHELLI M.; GARCIA-TOUCHARD A.; MANZO S.; CAIAZZO G.; MOREU J.; FORES J. S.; DONAZZAN L.; VIGNALI L.; TELES R.; BENIT E.; AGOSTONI P.; OJEDA F. B.; LEHTOLA H.; CAMACHO-FREIERE S.; KRAAIJEVELD A.; ANTTI Y.; BOCCALATTE M.; DEHARO P.; MARTINEZ-LUENGAS I. L.; SCHELLER B.; VARYTIMIADI E.; MORENO R.; UCCELLO G.; FAURIE B.; BARRIOS A. G.; MILEWSKI M.; BRUWIERE E.; SMITS P.; WILBERT B.; DI UCCIO F. S.; PARODI G.; KEDHI E.; VERDOIA M.
• Rok publikování: 2021
• Druh: Článek v odborném periodiku
• Časopis / Zdroj: Atherosclerosis
• Fakulta / Pracoviště MU: Lékařská fakulta
• www: https://www.sciencedirect.com/science/article/pii/S0021915021012156?via%3Dihub
• Doi: http://dx.doi.org/10.1016/j.atherosclerosis.2021.06.926
• Klíčová slova: SARS-CoV-2; ST segment elevation myocardial infarction; Thrombosis(please add them)
• Popis: Background and aims: SARS-Cov-2 predisposes patients to thrombotic complications, due to excessive inflam-mation, 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). Methods: 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. Results: 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 symbolscript 0.004) and heart failure (22.6% vs 10.6%, p symbolscript 0.001) that was confirmed after adjustment for confounding factors. Conclusions: 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.