Background: Coronavirus Disease-2019 (COVID-19) may impair outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The extent of this phenomenon and its mechanisms are unclear. Methods and Results: This study prospectively included 50 consecutive STEMI patients admitted to our center for primary percutaneous coronary intervention (PCI) at the peak of the Italian COVID-19 outbreak. At admission, a COVID-19 test was positive in 24 patients (48%), negative in 26 (52%). The primary endpoint was in-hospital all-cause mortality. Upon admission, COVID-19 subjects had lower PO2/FiO2 (169 [100–425] vs. 390 [302–477], P<0.01), more need for oxygen support (62.5% vs. 26.9%, P=0.02) and a higher rate of myocardial dysfunction (ejection fraction <30% in 45.8% vs. 19.2%, P=0.04). All patients underwent emergency angiography. In 12.5% of COVID-19 patients, no culprit lesions were detected, thus PCI was performed in 87.5% and 100% of COVID-19 positive and negative patients, respectively (P=0.10). Despite a higher rate of obstinate thrombosis in the COVID-19 group (47.6% vs. 11.5%, P<0.01), the PCI result was similar (TIMI 2-3 in 90.5% vs. 100%, P=0.19). In-hospital mortality was 41.7% and 3.8% in COVID-19 positive and negative patients, respectively (P<0.01). Respiratory failure was the leading cause of death (80%) in the COVID-19 group, frequently associated with severe myocardial dysfunction. Conclusions: In-hospital mortality of COVID-19 patients with STEMI remains high despite successful PCI, mainly due to coexisting severe respiratory failure. This may be a critical factor in patient management and treatment selection.

Pellegrini, D., Fiocca, L., Pescetelli, I., Canova, P., Vassileva, A., Faggi, L., et al. (2021). Effect of respiratory impairment on the outcomes of primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction and Coronavirus disease-2019 (COVID-19). CIRCULATION JOURNAL, 85(10), 1701-1707 [10.1253/circj.CJ-20-1166].

Effect of respiratory impairment on the outcomes of primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction and Coronavirus disease-2019 (COVID-19)

Senni M;
2021

Abstract

Background: Coronavirus Disease-2019 (COVID-19) may impair outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The extent of this phenomenon and its mechanisms are unclear. Methods and Results: This study prospectively included 50 consecutive STEMI patients admitted to our center for primary percutaneous coronary intervention (PCI) at the peak of the Italian COVID-19 outbreak. At admission, a COVID-19 test was positive in 24 patients (48%), negative in 26 (52%). The primary endpoint was in-hospital all-cause mortality. Upon admission, COVID-19 subjects had lower PO2/FiO2 (169 [100–425] vs. 390 [302–477], P<0.01), more need for oxygen support (62.5% vs. 26.9%, P=0.02) and a higher rate of myocardial dysfunction (ejection fraction <30% in 45.8% vs. 19.2%, P=0.04). All patients underwent emergency angiography. In 12.5% of COVID-19 patients, no culprit lesions were detected, thus PCI was performed in 87.5% and 100% of COVID-19 positive and negative patients, respectively (P=0.10). Despite a higher rate of obstinate thrombosis in the COVID-19 group (47.6% vs. 11.5%, P<0.01), the PCI result was similar (TIMI 2-3 in 90.5% vs. 100%, P=0.19). In-hospital mortality was 41.7% and 3.8% in COVID-19 positive and negative patients, respectively (P<0.01). Respiratory failure was the leading cause of death (80%) in the COVID-19 group, frequently associated with severe myocardial dysfunction. Conclusions: In-hospital mortality of COVID-19 patients with STEMI remains high despite successful PCI, mainly due to coexisting severe respiratory failure. This may be a critical factor in patient management and treatment selection.
Articolo in rivista - Articolo scientifico
Acute coronary syndromes; Acute myocardial infarction; Coronary revascularization; Percutaneous coronary intervention; SARS-COV2;
English
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1707
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Pellegrini, D., Fiocca, L., Pescetelli, I., Canova, P., Vassileva, A., Faggi, L., et al. (2021). Effect of respiratory impairment on the outcomes of primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction and Coronavirus disease-2019 (COVID-19). CIRCULATION JOURNAL, 85(10), 1701-1707 [10.1253/circj.CJ-20-1166].
Pellegrini, D; Fiocca, L; Pescetelli, I; Canova, P; Vassileva, A; Faggi, L; Senni, M; Guagliumi, G
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/373402
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