ST-Segment Elevation Myocardial Infarction in the Time of COVID-19

This study cites the experience of 6 sites during the first month of the COVID-19 pandemic in New York. All patients included had a confirmed diagnosis of coronavirus infection and also ST-segment elevation on electrocardiography.

Eighteen patients met these criteria. We are used to large randomized studies; consequently, this small registry of less than 20 people seems to fall short, but it is all we have so far.

The mean age for the studied subjects was 63 years old and most patients were male. Only a third of this group experienced chest pain along the ST-segment elevation.

Half the patients admitted with COVID-19 symptoms had ST-segment elevation in the initial electrocardiography, while all others developed it during hospitalization.

Half the group (9 patients) ended up in the cath lab; 6 patients had obstructive lesions and 5 underwent angioplasty.

Read also: Procedural Rescheduling Criteria in the Pandemic Era.

About half these patients had a “conventional” ST-segment elevation myocardial infarction; the other half experienced myocardial injury without any associated coronary disease.

Most included patients (72%) passed away at the hospital (4 patients with coronary disease and 9 with myocardial injury without coronary lesions).

In this series of patients affected by the new coronavirus and ST-segment elevation, there was a high prevalence of nonobstructive disease and a high mortality rate.

Read also: Reperfusion in the Time of COVID-19. What Has Changed?

Myocardial injuries in patients with COVID-19 may result from plaque rupture, cytokine storm, hypoxic injury, coronary spasm, microthrombi, or direct endothelial injury.

All patients had interstitial edema on magnetic resonance imaging.

Original Title: ST-Segment Elevation in Patients with Covid-19 — A Case Series.

Reference: Sripal Bangalore et al. The New England Journal of Medicine, article in press.   

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