Acute ST-segment elevation myocardial infarction in COVID-19 patients: a single hospital experience

The COVID-19 pandemic has dramatically changed the lives of people and the work of hospitals and the health system. The rapid spread of infection, high mortality and congestion in hospitals are of high concern. Due to insufficiently causes, the number of admissions of patients with acute coronary syndrome (ACS) has significantly decreased in many centers, while timely intervention significantly improves the prognosis of AMI patients with ST segment elevation. Aim. To assess the clinical characteristics of patients with ST-segment elevation AMI during the re-profiling of the center for patients with COVID-19. Materials and methods. In total, the center worked to receive patients with COVID-19 and ACS for one month, during which 8 AMI patients with ST segment elevation were hospitalized. SARS-CoV-2 was diagnosed on the basis of nasopharyngeal or oropharyngeal smear PCR, serum IgM and IgG, or lung CT, which were performed on the day of admission, regardless of the severity of the condition. Segment elevation AMI was diagnosed based on typical clinical presentations accompanied by ST-segment elevation or newly diagnosed LBBB. Stenosis was considered as an infarction-related lesion in the presence of angiographic signs of thrombotic occlusion or subocclusion. Obstructive coronary artery disease was defined as >50% stenosis based on visual assessment of angiography. Results. All patients had ST-segment elevation, 6 (75%) patients had typical pain syndrome, 2 (25%) patients had pain syndrome accompanied by shortness of breath. SARS-CoV-2 was detected by PCR in 4 (50%), in 2 (25%) - an increased titer of IgM and IgG. CT scan showed 7 (87.5%) changes characteristic of COVID-19. Severe (CT3) and moderately severe (CT2) lesions were found in 4 (50%) patients. All patients underwent coronary angiography, thrombolysis was not performed. All patients had obstructive coronary artery disease requiring revascularization. When compared with the same calendar interval of the previous 3 years, the decrease in hospitalization for AMI with ST elevation was 50% or more. However, when comparing pain-door and door-balloon time intervals, no significant differences were found (p=0.786 and p=0.300, respectively). Conclusion. All patients with suspected ST-segment elevation AMI had obstructive coronary artery disease requiring revascularization. There was a significant decrease in the number of patients with AMI with ST-segment elevation without changing the time intervals before hospitalization and intervention.

COVID-19, acute myocardial infarction, COVID-19, revascularization