Angiographic and Electrocardiographic Characteristics of Patients With Non–ST-Segment Elevation Myocardial Infarction and COVID-19

Background: COVID-19 may contribute to worse outcomes in acute coronary syndromes through exaggerated inflammation, platelet activation, and endothelial injury, creating a prothrombotic environment. Mortality in ST-segment elevation myocardial infarction (STEMI) with concurrent COVID-19 is markedly higher than in prepandemic cohorts. We characterize patients with non-ST-segment elevation myocardial infarction (NSTEMI) and COVID-19 using core laboratory adjudicated data. Methods: We conducted a retrospective analysis of patients with NSTEMI and laboratory-confirmed COVID-19 from the William Osler Health System. Coronary angiograms and electrocardiograms were evaluated by the independent core laboratories. Results: Overall, 155 patients (29.7% women, median age 67 years) were included. In-hospital mortality was 8.4%. In total, 67 patients underwent percutaneous coronary intervention, with 22.3% being unsuccessful. High thrombus grade (3-5) at presentation was observed in 43.3% of patients, and among those with a prior stent, 25% had stent thrombosis. Global systolic dysfunction occurred in 32.3% of patients. Electrocardiograms demonstrated diffuse, nonlocalizing ST changes, with a high prevalence of ST elevation in aVR (33%), conduction abnormalities (19.4%), and Q waves (16.9%), suggesting diffuse thrombotic disease. Conclusions: This is the first core laboratory description of NSTEMI patients with COVID-19. Compared with prepandemic NSTEMI cohorts, these patients experience higher mortality and lower procedural success rates, likely driven by diffuse thrombotic disease.