Changes in characteristics and management among patients withST-elevation myocardial infarction due toCOVID-19 infection
Changes in characteristics and management among patients withST-elevation myocardial infarction due toCOVID-19 infection
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DOI：
10.1002/ccd.29114
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发表时间：
2020-07-15
影响因子：
2.3
通讯作者：
Camenzind, Edoardo
中科院分区：
文献类型：
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作者：
Popovic, Batric;Varlot, Jeanne;Camenzind, Edoardo
目的评价冠状病毒病（COVID-19）合并ST段抬高型心肌梗死（STEMI）患者行直接经皮冠状动脉介入治疗（PCI）后的特征变化和治疗。方法我们的前瞻性单中心研究纳入了在COVID-19爆发期间接受PPCI的所有STEMI患者（n= 83）。该队列首先与之前的STEMI患者队列（2008-2017年，n= 1，552例患者）进行比较，然后分为非COVID-19组（n= 72）和COVID-19组（n= 11）。结果与暴发前相比，暴发期患者年龄偏大（59.6 +/- 12.9 vs. 62.6 +/-12.2，p = .03）延迟寻求护理（首次球囊扩张平均延迟3.8 +/- 3 vs.7.4 +/- 7.7，p <0.001）导致住院死亡率高出两倍（非COVID-19 4.3% vs. COVID-19 8.4%，p = 0.07）。在疫情期间收治的83名STEMI患者中，有11名患者感染了COVID-19。在COVID-19组中观察到4例患者的炎症生物标志物（C反应蛋白：28 +/- 39 vs. 98 +/- 97 mg/L，p= .04）、纤维蛋白溶解生物标志物（D二聚体：804 +/-1，500 vs. 3，128 +/-2，458 μ g/L，p= .02）和抗磷脂抗体较高。在该组中，血管造影数据也不同：在11例病例中观察到血栓性心肌梗死非动脉粥样硬化性冠状动脉闭塞（MINOCA）（1.4% vs. 54.5%，p <0.001），并与术后远端栓塞较高（30.6% vs. 72.7%，p = 0.007）相关。COVID-19组的住院死亡率显著较高（5.6% vs. 27.3%，p = 0.016）。结论COVID-19爆发意味着STEMI患者的病因和治疗管理发生了深刻变化。在这一特定人群中，全身性炎症和高凝状态对早期和长期结局的影响是有必要的。
Objectives To assess changes in characteristics and management among ST-elevation myocardial infarction (STEMI) patients with coronavirus disease (COVID-19) who underwent primary percutaneous coronary intervention. Methods Our prospective, monocentric study enrolled all STEMI patients who underwent PPCI during the COVID-19 outbreak (n= 83). This cohort was first compared with a previous cohort of STEMI patients (2008-2017,n= 1,552 patients) and was then dichotomized into a non-COVID-19 group (n= 72) and COVID-19 group (n= 11). Results In comparison with the pre-outbreak period, patients during the outbreak period were older (59.6 +/- 12.9 vs. 62.6 +/- 12.2,p= .03) with a delayed seek to care (mean delay first symptoms-balloon 3.8 +/- 3 vs. .7.4 +/- 7.7,p < .001) resulting in a two-fold higher in-hospital mortality (non COVID-19 4.3% vs. COVID-19 8.4%,p= .07). Among the 83 STEMI patients admitted during the outbreak period, 11 patients were infected by COVID-19. Higher biological markers of inflammation (C-reactive protein: 28 +/- 39 vs. 98 +/- 97 mg/L,p= .04), of fibrinolysis (D-dimer: 804 +/- 1,500 vs. 3,128 +/- 2,458 mu g/L,p= .02), and antiphospholipid antibodies in four cases were observed in the COVID-19 group. In this group, angiographic data also differed: a thrombotic myocardial infarction nonatherosclerotic coronary occlusion (MINOCA) was observed in 11 cases (1.4% vs. 54.5%,p < .001) and associated with higher post-procedure distal embolization (30.6% vs. 72.7%,p= .007). The in hospital mortality was significantly higher in the COVID-19 group (5.6% vs. 27.3%,p= .016). Conclusion The COVID-19 outbreak implies deep changes in the etiopathogenesis and therapeutic management of STEMI patients with COVID-19. The impact on early and long-term outcomes of systemic inflammation and hypercoagulability in this specific population is warranted.