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

Authors	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.
Year of publication	2021
Type	Article in Periodical
Magazine / Source	Atherosclerosis
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://www.sciencedirect.com/science/article/pii/S0021915021012156?via%3Dihub
Doi	http://dx.doi.org/10.1016/j.atherosclerosis.2021.06.926
Keywords	SARS-CoV-2; ST segment elevation myocardial infarction; Thrombosis(please add them)
Description	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.