Outcomes of Primary Percutaneous Coronary Intervention in Post COVID-19 Patients Presenting with ST Segment Elevation Myocardial Infarction
Authors: Elmasry Nadeem M , El-Abd Ali A , Helmy Haitham G , Fakhry Hany M 
Published: July 2024

Abstract

Background
Coronavirus disease-2019 (COVID-19) is thought to predispose patients to wide variety of thrombotic disease, including Acute Coronary Syndromes (ACS). While such fact is established in literature to occur during the acute infection, data regarding the long term thrombotic effects of COVID-19 are still unclear.

Aim and Objectives
To determine the special coronary angiographic findings, the procedural and clinical success of revascularization among post COVID-19 patients presenting with STEMI.

Patients and Methods
This study was performed on a 100 patients who presented to emergency departments of Ain shams university hospitals with ST Segment Elevation Myocardial Infarction and underwent primary PCI, during a period of 6 months: From January to June of 2022. The patients were randomized into two groups: Group (A) the Post COVID-19 group, comprising 50 patients who developed COVID-19 infection in the past 6 months, as diagnosed at the time by RT-PCR or a CT chest of CORADS-IV or more – and group (B) the Control group, comprising 50 patients who deny COVID-19 infection in the past 6 months, endorsed by a negative COVID-19 antibody test. A subgroup analysis was done where patients in group (A) were further divided into two subgroups: the Early Post-COVID subgroup, having developed STEMI within 8 weeks of infection and comprising 16 patients, and the Late Post-COVID subgroup, having developed STEMI &gt;8-24 weeks post infection and comprising 34 patients. The groups were compared as regards clinical, angiographic, laboratory and echocardiographic outcomes of percutaneous intervention.

Results
Our study demonstrated that patients who developed STEMI within 8 weeks of a COVID-19 infection (the Early Post-COVID subgroup) showed a statistically significant high thrombus burden on angiography, at 81.3% versus 48% of the control group. A high thrombus burden was defined in our study as having a modified thrombus grade of 4 or more. This subsequently resulted in higher use of pre-dilatation (56.2% versus 24%) and thrombus aspiration (43.8% versus 4%) in the Early Post- COVID subgroup, both at a statistically significant level (P-values = 0.015 and 0.001 respectively). Coronary No-Reflow was a much more frequent complication following PCI in the Early post-COVID subgroup (62.5%) compared to the Control group (22%). These patients also suffered a lower Ejection Fraction on Echocardiography (Mean 36% versus 43.4%) and a larger LVIDs (Mean 47mm versus 43.9mm) as compared to the Control group. This data translated clinically into a higher MACE among the Early Post-COVID patients, at 31.3% versus 6% of the control group. Of note that these differences were not as evident upon comparing the whole post COVID group to the control group.

Conclusion
We concluded that the thrombogenic effect of COVID-19 on the outcomes of STEMI persists even after resolution of the infection but gradually declines overtime. It affects the angiographic, procedural and overall clinical success of revascularization during in-hospital stay. This effect is maximal during the first 8 weeks after infection, but declines thereafter.