Clinical Memory of COVID-19 Pandemic: A Comparative Analysis of Clinical and Angiographic Characteristics of Patients with Acute Coronary Syndrome

Abstract

Objectives: To describe the clinical characteristics and angiographic features of COVID-19 patients presenting with acute coronary syndrome (ACS) and to compare with non-COVID-19 ACS patients presenting simultaneously.

Methodology: In a case control design, data were extracted from a prospectively collected COVID-19 and NCDR registry. All ACS patients who underwent cardiac catheterization from April 2020 to May 2021 were included. All of the patients were taken to the Cath lab for diagnostic coronary angiography and possible percutaneous intervention. Demographic and clinical characteristics, angiographic features, and in-hospital outcomes were compared between ACS patients with and without COVID-19.

Results: A total of 4027 COVID-19 negative patients, and 80 COVID-19 positive were included. Total of 83% in COVID-19 and 88% in non-COVID-19 group had ST elevation myocardial infarction. Majority of the COVID-19 positive patients had sub-optimal TIMI flow grade (<III) post procedure and had a high thrombus burden (11.2% vs. 2.9%; p<0.001). Majority of the patients who had COVID-19 and ACS required mechanical circulatory support (48.8% vs. 0.3%; p<0.001). The mortality rates were also higher in COVID-19 positive group (38.8% vs. 1.3%; p<0.001). Among the COVID-19 positive patients 66.3% (53) had high thrombus burden (≥4 grade), intervention was performed in 73.7% (59). Post-intervention myocardial blush grade ≤2 was observed in 57.6% (34), slow flow in 85.3% (29), and phasic flow possibly due to elevated LVEDP in 41.2% (14) patients.

Conclusion: COVID-19 patients with ACS had a higher severity of illness at presentation and worse outcomes as compared to simultaneously presenting non-COVID patients.