ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION IN PATIENTS WITH A HISTORY OF COVID-19: MYOCARDIAL PERFUSION RECOVERY AND CLINICAL COURSE FEATURES
DOI:
https://doi.org/10.11603/1811-2471.2025.v.i3.15562Keywords:
ST-segment elevation myocardial infarction, prior COVID-19, infarct-related coronary artery stenting, myocardial perfusion, clinical course featuresAbstract
SUMMARY. Acute ST-segment elevation myocardial infarction (STEMI) remains one of the leading causes of in-hospital mortality today. The priority in the treatment of such patients is the earliest possible initiation of reperfusion therapy aimed at restoring patency of the infarct-related coronary artery (IRA) through stent implantation. The clinical course of STEMI depends on the quality of myocardial perfusion recovery and the presence of patient's risk factors (RFs), among which a history of COVID-19 is receiving increasing attention.
The aim – to assess the clinical course characteristics of STEMI in patients with a history of COVID-19, focusing on the effectiveness of myocardial perfusion restoration after IRA stenting, systemic inflammation activity, manifestations of heart failure, types of arrhythmias, and myocardial structural and functional parameters.
Material and Methods. The study included 135 patients with STEMI who underwent percutaneous coronary intervention (PCI) with IRA stenting within 24 hours of symptom onset. Patients were divided into two groups: those with a prior history of COVID-19 (n=76) and those without this risk factor (n=59). Levels of C-reactive protein (CRP), fibrinogen (Fg), NT-proBNP, glomerular filtration rate (GFR), results of 24-hour electrocardiographic (ECG) monitoring, echocardiographic parameters, myocardial perfusion according to the Myocardial Blush Grade (MBG) scale, and left ventricular (LV) geometry were evaluated.
Results. Complete coronary blood flow restoration (TIMI-3) was achieved in all patients. Optimal myocardial perfusion (MBG TIMI-3 = 3) was observed in approximately two-thirds of the cohort. Among patients with suboptimal myocardial perfusion recovery (MBG TIMI-3 ≤ 2), significantly higher levels of CRP, fibrinogen, and NT-proBNP were found, with statistically higher values in individuals with a history of COVID-19 compared to those without this risk factor. All patients showed mild renal dysfunction based on GFR values. Within 24 hours post-PCI, 24-hour ECG monitoring revealed frequent supraventricular and ventricular extrasystoles and tachycardia paroxysms, with a tendency toward more frequent supraventricular arrhythmias and longer episodes of ventricular tachycardia in prior COVID-19 patients. In patients with impaired myocardial perfusion, echocardiographic indicators of myocardial structure and function – such as increased end-diastolic diameter and reduced left ventricular ejection fraction (LVEF) – were more markedly altered compared to those with optimal perfusion. Notably, in patients with a history of COVID-19, LVEF tended to decline over time, whereas in those without this risk factor, it improved (p≥0.05). Pathological LV remodeling was more frequently observed in patients with a history of COVID-19.
Conclusions. A history of coronavirus disease represents a significant risk factor for adverse outcomes in patients with STEMI. In this population, impaired myocardial perfusion is associated with heightened systemic inflammation, more severe manifestations of heart failure, a higher incidence of supraventricular arrhythmias, poorer structural and functional myocardial parameters, and an increased prevalence of pathological left ventricular remodeling.
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