Angiographic characteristics of Patients with STEMI and COVID-19 – Insights from NACMI Registry

Background To date, there has been no independent core lab angiographic analysis of patients with COVID-19 and STEMI. The study characterized the angiographic parameters of patients with COVID-19 and STEMI. Methods Angiograms of patients with COVID-19 and STEMI from the North American COVID-19 Myocardial Infarction (NACMI) Registry were sent to a Core Laboratory in Vancouver, Canada. Culprit lesion(s), Thrombolysis In Myocardial Infarction (TIMI) flow, Thrombus Grade Burden (TGB), and percutaneous coronary intervention (PCI) outcome were assessed. Results From 234 patients, 74% had one culprit lesion, 14% had multiple culprits and 12% had no culprit identified. Multi-vessel thrombotic disease and multi-vessel CAD were found in 27% and 53% of patients, respectively. Stent thrombosis accounted for 12% of the presentations and occurred in 55% of patients with previous coronary stents. Of the 182 who underwent PCI, 60 (33%) had unsuccessful PCI due to post-PCI TIMI flow <3 (43/60), residual high thrombus burden (41/60) and/or thrombus related complications (27/60). In-hospital mortality for successful, partially successful, and unsuccessful PCI was 14%, 13%, and 27%, respectively. Unsuccessful PCI was associated with increased risk of in-hospital mortality [risk ratio (RR) 1.96; 95%CI: 1.05-3.66, p=0.03]; in the adjusted model this estimate was attenuated (RR:1.24; 95%CI: 0.65-2.34, p=0.51). Conclusion In patients with COVID-19 and STEMI, thrombus burden was pervasive with notable rates of multi-vessel thrombotic disease and stent thrombosis. Post-PCI, persistent thrombus and sub-optimal TIMI 3 flow rates led to one-third of the PCI's being unsuccessful, which decreased over time but remained an important predictor of in-hospital mortality.