COVID-19 patients with STEMI present specialists with new challenges

COVID-19 patients presenting with ST-segment elevation myocardial infarction (STEMI) experience a high rate of stent thrombosis, according to new data published the American Journal of Cardiology. What does this tell us about the management of these patients going forward?

“Despite the burgeoning literature regarding the general COVID-19 positive population, little is known about the specific clinical characteristics and outcomes of patients with active COVID-19 infection presenting with STEMI,” wrote first author Anas Hamadeh, MD, Baylor University Medical Center in Dallas, and colleagues.

To learn about these patients, the authors tracked data from 78 individuals hospitalized with COVID-19 and STEMI in Lithuania, Italy, Spain and Iraq. All patients were treated from Feb. 1 to April 15, 2020, and presented with at least one comorbidity. The median patient age was 65 years old.

Overall, 10% of patients developed respiratory distress syndrome, and 18% required ventilation. While 76% of patients were treated with fibrinolytic therapy, the other 24% were treated with primary percutaneous coronary intervention (PCI). Stent thrombosis occurred in 21% of patients treated with primary PCI. Fibrinolysis was successful in 85% of patients treated with fibrinolytic therapy; when it was unsuccessful, one patient died prior to PCI and the other patients all underwent PCI. Twelve percent of patients died.

Hamadeh et al. noted that the standard of care for traditional STEMI patients is invasive revascularization within 90 minutes, with fibrinolytic therapy being used as an alternative if care is expected to be delayed beyond that 90-minute window. However, thrombotic complications are much more common among COVID-19 patients, which “could explain why patients in our study had a higher-than-expected rate of stent thrombosis.”

“This is the largest case series to-date of COVID-19 positive patients presenting with STEMI and spans 4 countries,” the authors concluded. “We found a high rate of thrombotic complications and a very high mortality rate. Our results suggest a possible need to adapt STEMI management for patients with concurrent COVID-19 infection.”

The full study can be read here.

Additional coverage related to COVID-19 and STEMI care is available here.