ST-Elevation Myocardial Infarction in Patients with COVID-19: Clinical and Angiographic Outcomes

Question: What are the cardiac characteristics of COVID – 19 patients presenting with STEMI.

Population: This report describes the angiographic findings and outcomes of 28 COVID – 19 patients who presented with STEMI from hospitals in the Lombardy Region of Italy.

Key Points:

  • Presentation – 28 patients – 25 with localized ST elevation (89.3%) and 3 with a new LBBB (10.7%).
  • Mean age -68+11 years, 28.6% women, 71.4% men.
  • Risk factors included Diabetes 32.1%, chronic kidney disease 28.6% and prior myocardial infarction 10.7%.
  • STEMI was the first clinical manifestation of COVID in 24 patients (85.7%) and COVID – 19 status was not known at the time of coronary angiography. The other 4 patients developed STEMI during hospitalization.
  • Echocardiography was performed in all patients with 23/28 (82.1%) having segmental wall motion changes.
  • At coronary angiography, 17 (60.7%) patients had a culprit lesion treated with PCI; 11 patients (39.3%) had no significant obstructive disease.
  • At mean follow-up of 13 days, 11 patients died (39.3%); 16 patients (57.1%) were discharged and 1 patient was still hospitalized in the ICU.
  • Thus ~40% of STEMI patients with COVID – 19 had no significant coronary disease reaffirming the potential harm of treating with routine thrombolytics. Data is not available to differentiate type 2 myocardial infarction from COVID – 19 myocarditis or other unique etiologies such as COVID induced endothelial dysfunction and/or myocarditis or cytokine storm.
  • While the numbers are small, the report emphasizes the point that acute STEMI presentations may be quite different in the setting of COVID – 19.