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

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.; Berg, J. T.; Laine, M.; Dirksen, M.; Siviglia, M.; Casella, G.; Kala, P.; Diez Gil, J. L.; 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.; Gutierrez Barrios, A.; Milewski, M.; Bruwiere, E.; Smits, P.; Wilbert, B.; Di Uccio, F. S.; Parodi, G.; Kedhi, E.; Verdoia, M.

doi:10.1016/j.atherosclerosis.2021.06.926

Background and aims: SARS-Cov-2 predisposes patients to thrombotic complications, due to excessive inflammation, 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 = 0.004) and heart failure (22.6% vs 10.6%, p = 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.

Impact of SARS-CoV-2 positivity on clinical outcome among STEMI patients undergoing mechanical reperfusion: Insights from the ISACS STEMI COVID 19 registry / 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.; Berg, J. T.; Laine, M.; Dirksen, M.; Siviglia, M.; Casella, G.; Kala, P.; Diez Gil, J. L.; 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.; Gutierrez Barrios, A.; Milewski, M.; Bruwiere, E.; Smits, P.; Wilbert, B.; Di Uccio, F. S.; Parodi, G.; Kedhi, E.; Verdoia, M.. - In: ATHEROSCLEROSIS. - ISSN 0021-9150. - 332:(2021), pp. 48-54. [10.1016/j.atherosclerosis.2021.06.926]