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

  • 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.
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.

Published
2022-10-11
Section
Articles