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Impact of SARS-CoV-2 positivity on clinical outcome among STEMI patients undergoing mechanical reperfusion: Insights from the ISACS STEMI COVID 19 registry
Atherosclerosis ( IF 5.3 ) Pub Date : 2021-07-21 , DOI: 10.1016/j.atherosclerosis.2021.06.926
Giuseppe De Luca 1 , Niels Debel 2 , Miha Cercek 3 , Lisette Okkels Jensen 4 , Marija Vavlukis 5 , Lucian Calmac 6 , Tom Johnson 7 , Gerard Rourai Ferrer 8 , Vladimir Ganyukov 9 , Wojtek Wojakowski 10 , Tim Kinnaird 11 , Clemens von Birgelen 12 , Yves Cottin 13 , Alexander IJsselmuiden 14 , Bernardo Tuccillo 15 , Francesco Versaci 16 , Kees-Jan Royaards 17 , Jurrien Ten Berg 18 , Mika Laine 19 , Maurits Dirksen 20 , Massimo Siviglia 21 , Gianni Casella 22 , Petr Kala 23 , José Luis Díez Gil 24 , Adrian Banning 25 , Victor Becerra 26 , Ciro De Simone 27 , Andrea Santucci 28 , Xavier Carrillo 29 , Alessandra Scoccia 30 , Giovanni Amoroso 31 , Arnoud Wj Van't Hof 32 , Tomas Kovarnik 33 , Grigorios Tsigkas 34 , Julinda Mehilli 35 , Gabriele Gabrielli 36 , Xacobe Flores Rios 37 , Nikola Bakraceski 38 , Sébastien Levesque 39 , Giuseppe Cirrincione 40 , Vincenzo Guiducci 41 , Michał Kidawa 42 , Leonardo Spedicato 43 , Lucia Marinucci 44 , Peter Ludman 45 , Filippo Zilio 46 , Gennaro Galasso 47 , Enrico Fabris 48 , Maurizio Menichelli 49 , Arturo Garcia-Touchard 50 , Stephane Manzo 51 , Gianluca Caiazzo 52 , Jose Moreu 53 , Juan Sanchis Forés 54 , Luca Donazzan 55 , Luigi Vignali 56 , Rui Teles 57 , Edouard Benit 58 , Pierfrancesco Agostoni 59 , Francisco Bosa Ojeda 60 , Heidi Lehtola 61 , Santiago Camacho-Freiere 62 , Adriaan Kraaijeveld 63 , Ylitalo Antti 64 , Marco Boccalatte 65 , Pierre Deharo 66 , Iñigo Lozano Martínez-Luengas 67 , Bruno Scheller 68 , Efthymia Varytimiadi 69 , Raul Moreno 70 , Giuseppe Uccello 71 , Benjamin Faurie 72 , Alejandro Gutierrez Barrios 73 , Marek Milewski 74 , Ewout Bruwiere 58 , Pieter Smits 17 , Bor Wilbert 18 , Fortunato Scotto Di Uccio 15 , Guido Parodi 75 , Elvin Kedhi 76 , Monica Verdoia 77
Affiliation  

Background and aims

SARS-Cov-2 predisposes patients to thrombotic complications, due to excessive inflammation, endothelial dysfunction, platelet activation, and coagulation/fibrinolysis disturbances. The aim of the present study was to evaluate clinical characteristics and prognostic impact of SARS-CoV-2 positivity among STEMI patients undergoing primary percutaneous coronary intervention (PPCI).

Methods

We selected SARS-CoV-2 positive patients included in the ISACS-STEMI COVID-19, a retrospective multicenter European registry including 6609 STEMI patients treated with PPCI from March 1st until April 30th, in 2019 and 2020. As a reference group, we randomly sampled 5 SARS-Cov-2 negative patients per each SARS-CoV-2 positive patient, individually matched for age, sex, and hospital/geographic area. Study endpoints were in-hospital mortality, definite stent thrombosis, heart failure.

Results

Our population is represented by 62 positive SARS-CoV-2 positive patients who were compared with a matched population of 310 STEMI patients. No significant difference was observed in baseline characteristics or the modality of access to the PCI center. In the SARS-CoV-2 positive patients, the culprit lesion was more often located in the RCA (p < 0.001). Despite similar pre and postprocedural TIMI flow, we observed a trend in higher use of GP IIb-IIIa inhibitors and a significantly higher use of thrombectomy in the SARS-CoV-2 positive patients. SARS-CoV-2 positivity was associated with a remarkably higher in hospital mortality (29% vs 5.5%, p < 0.001), definite in-stent thrombosis (8.1% vs 1.6%, p = 0.004) and heart failure (22.6% vs 10.6%, p = 0.001) that was confirmed after adjustment for confounding factors.

Conclusions

Our study showed that among STEMI patients, SARS-CoV-2 positivity is associated with larger thrombus burden, a remarkably higher mortality but also higher rates of in-stent thrombosis and heart failure.



中文翻译:

SARS-CoV-2 阳性对接受机械再灌注的 STEMI 患者临床结果的影响:来自 ISACS STEMI COVID 19 注册的见解

背景和目标

由于过度炎症、内皮功能障碍、血小板活化和凝血/纤维蛋白溶解障碍,SARS-Cov-2 使患者易患血栓并发症。本研究的目的是评估接受直接经皮冠状动脉介入治疗 (PPCI) 的 STEMI 患者中 SARS-CoV-2 阳性的临床特征和预后影响。

方法

我们选择了 ISACS-STEMI COVID-19 中包含的 SARS-CoV-2 阳性患者,ISACS-STEMI COVID-19 是一项回顾性多中心欧洲登记处,包括 6609 名从 2019 年和 2020 年 3 月 1 日至 4 月 30 日接受 PPCI 治疗的 STEMI 患者。作为参考组,我们随机对每个 SARS-CoV-2 阳性患者采样了 5 名 SARS-Cov-2 阴性患者,年龄、性别和医院/地理区域分别匹配。研究终点是住院死亡率、明确的支架血栓形成、心力衰竭。

结果

我们的人群由 62 名 SARS-CoV-2 阳性患者代表,他们与 310 名 STEMI 患者的匹配人群进行了比较。在基线特征或进入 PCI 中心的方式方面没有观察到显着差异。在 SARS-CoV-2 阳性患者中,罪魁祸首更常位于 RCA(p  < 0.001)。尽管术前和术后 TIMI 流程相似,但我们观察到在 SARS-CoV-2 阳性患者中更多使用 GP IIb-IIIa 抑制剂和血栓切除术使用率显着增加的趋势。SARS-CoV-2 阳性与住院死亡率(29%5.5%,p  < 0.001)、明确的支架内血栓形成(8.1%1.6%,p = 0.004) 和心力衰竭 (22.6% vs 10.6%, p  = 0.001) 在调整混杂因素后得到确认。

结论

我们的研究表明,在 STEMI 患者中,SARS-CoV-2 阳性与更大的血栓负荷、显着更高的死亡率以及更高的支架内血栓形成和心力衰竭发生率相关。

更新日期:2021-08-11
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