Key result
COVID-19 in ACS is linked to ~15-fold higher rates of impaired myocardial perfusion and mortality.
Why the study?
COVID-19 is considered to deteriorate endothelial function via hyperinflammation, but microvascular dysfunction in COVID-19 patients with ACS required investigation using angiographic parameters.
Does COVID-19 infection worsen microvascular dysfunction and clinical outcomes in patients with acute coronary syndrome?
Observational (n=165)
Single-blind
No
Does COVID-19 infection worsen microvascular dysfunction and clinical outcomes in patients with acute coronary syndrome?
Absolute Event Rate: 57.7% vs 3.8%
p-value: p=<0.001
COVID-19 infection in patients with acute coronary syndrome is associated with significant microvascular impairment and a markedly higher risk of in-hospital mortality.
Suggests microvascular dysfunction in COVID-19 ACS via TFC/MBG; leaves open whether parameters inform prognosis or therapy.
Objective: Coronavirus disease 2019 (COVID-19) is considered to deteriorate endothelial function through hyperinflammation. We aimed to investigate microvascular dysfunction using the angiographic parameters thrombolysis in myocardial infarction frame count (TFC) and myocardial blush grade (MBG), in COVID-19 patients with acute coronary syndrome (ACS). Methods: One hundred and sixty-five patients presented with ACS (62.4% ST elevated myocardial infarction) and underwent percutaneous coronary intervention between March 1 and June 30, 2020, were enrolled in the study. The polymerase chain reaction test was performed in case of suggestive symptoms or typical computerized tomography findings. Results: Twenty-six patients (15.7%) were tested positive for COVID-19. Significantly higher values were observed in TFC in patients with COVID-19 (p<0.001), whereas COVID-19 patients had significantly lower MBGs (Grade 0 and 1) (p<0.001). Peak troponin-I value was also higher in the COVID-19 group (27335 vs. 15959 ng/dL, p=0.006). Mortality risk was higher in COVID-19 patients (38.4% vs. 7.2%, p<0.001). TFC and ejection fraction may predict in-hospital mortality among COVID-19 patients with ACS according to logistic regression results. In correlation analysis, TFC correlated positively with C-reactive protein (r=0.340, p<0.001) and peak troponin-I value (r=0.369, p<0.001). Conclusion: COVID-19 is associated with slow coronary flow and microvascular impairment in ACS.
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Erol Kalender (2023) conducted an observational in Acute Coronary Syndrome and COVID-19 (n=165). COVID-19 infection vs. COVID-19 negative was evaluated on Myocardial blush grade < 2 (impaired microvascular perfusion) (p=<0.001). COVID-19 infection in patients with acute coronary syndrome was associated with significantly higher rates of impaired myocardial perfusion (myocardial blush grade <2 in 57.7% vs 3.8%) and higher in-hospital mortality.
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