The Pragmatic Role of COVID-19 on the Thrombus Grade of Patients with Contemporary ST-Segment-Elevation Myocardial Infarction

Ata Firouzi; Zahra Hosseini; Zeinab Norouzi; Zohre Hosseini; Afshin Amirpour; Hamed Talakoob; Arash Amin; Abbas Soleimani; Nasrolah Moradifar; Shahrokh Karbalai; Mohammadhossein Mozafarybazargani; Hamidreza Hekmat; Majid Maleki; Parham Sadeghipour; Seyedeh Mahnaz Mirbod; Mina Ghorbanpoor Kohnaki; Hooman Bakhshandeh; Masoomeh Kalaei Nia; Fatemeh Sadate Habibizade; Sara Iraninejad; Mohammadreza Baay; Ehsan Khalilipur

doi:10.18502/jthc.v17i3.10842

Ata Firouzi Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Zahra Hosseini Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Zeinab Norouzi Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Zohre Hosseini Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Afshin Amirpour Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Hamed Talakoob Cardiovascular Research Center, Alborz University of Medical Sciences, Karaj, Iran.
Arash Amin Lorestan Heart Center, Madani Hospital, Lorestan University of Medical Sciences, Khorram Abad, Lorestan, Iran.
Abbas Soleimani Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Nasrolah Moradifar Lorestan Heart Center, Madani Hospital, Lorestan University of Medical Sciences, Khorram Abad, Lorestan, Iran.
Shahrokh Karbalai Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Mohammadhossein Mozafarybazargani Cardiovascular Research Center, Alborz University of Medical Sciences, Karaj, Iran.
Hamidreza Hekmat Ziaeian Hospital, International Campus, Tehran University of Medical Sciences, Tehran, Iran.
Majid Maleki Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Parham Sadeghipour Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Seyedeh Mahnaz Mirbod Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Mina Ghorbanpoor Kohnaki Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Hooman Bakhshandeh Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Masoomeh Kalaei Nia Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Fatemeh Sadate Habibizade Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Sara Iraninejad Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Mohammadreza Baay Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Ehsan Khalilipur Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/jthc.v17i3.10842

Keywords: STEMI; COVID-19; Thrombus burden; Primary PCI

Abstract

Background: Limited data exist on the clinical outcomes of patients with coronavirus disease 2019 (COVID-19) presenting with ST-segment-elevation myocardial infarction (STEMI).

Methods: This multicenter study, conducted in 6 centers in Iran, aimed to compare baseline clinical and procedural data between a case group, comprising STEMI patients with COVID-19, and a control group, comprising STEMI patients before the COVID-19 pandemic, and to determine in-hospital infarct-related artery thrombus grades and major adverse cardio-cerebrovascular events (MACCEs), defined as a composite of deaths from any cause (cardiovascular and noncardiovascular), nonfatal strokes, and stent thrombosis.

Results: No significant differences were observed between the 2 groups regarding baseline characteristics. Primary percutaneous coronary intervention (PPCI) was performed in 72.9% of the cases and 98.5% of the controls (P=0.043), and primary coronary artery bypass grafting was performed in 6.2% of the cases and 1.4% of the controls (P=0.048). Successful PPCI procedures (final TIMI flow grade III) were significantly fewer in the case group (66.5% vs 93.5%; P=0.001). The baseline thrombus grade before wire crossing was not statistically significantly different between the 2 groups. The summation of thrombus grades IV and V was 75% in the case group and 82% in the control group (P=0.432). The rate of MACCEs was 14.5% and 2.1% in the case and control groups, respectively (P=0.002).

Conclusion: In our study, the thrombus grade had no significant differences between the case and control groups; however, the in-hospital rates of the no-reflow phenomenon, periprocedural MI, mechanical complications, and MACCEs were statistically significantly higher in the case group.