Impact of SARS-CoV-2 positivity on clinical outcome among STEMI patients undergoing mechanical reperfusion: Insights from the ISACS STEMI COVID 19 registry

Giuseppe De Luca; Niels Debel; Miha Cercek; Lisette Okkels Jensen; Marija Vavlukis; Lucian Calmac; Tom Johnson; Gerard Rourai Ferrer; Vladimir Ganyukov; Wojtek Wojakowski; Tim Kinnaird; Clemens von Birgelen; Yves Cottin; Alexander IJsselmuiden; Bernardo Tuccillo; Francesco Versaci; Kees-Jan Royaards; Jurrien ten Berg; Mika Laine; Maurits Dirksen; Massimo Siviglia; Gianni Casella; Petr Kala; Jose Luis Diez Gil; Adrian Banning; Victor Becerra; Ciro De Simone; Andrea Santucci; Xavier Carrillo; Alessandra Scoccia; Giovanni Amoroso; Arnoud Wj van't Hof; Tomas Kovarnik; Grigorios Tsigkas; Julinda Mehilli; Gabriele Gabrielli; Xacobe Flores Rios; Nikola Bakraceski; Sebastien Levesque; Giuseppe Cirrincione; Vincenzo Guiducci; Michal Kidawa; Leonardo Spedicato; Lucia Marinucci; Peter Ludman; Filippo Zilio; Gennaro Galasso; Enrico Fabris; Maurizio Menichelli; Arturo Garcia-Touchard; Stephane Manzo; Gianluca Caiazzo; Jose Moreu; Juan Sanchis Fores; Luca Donazzan; Luigi Vignali; Rui Teles; Edouard Benit; Pierfrancesco Agostoni; Francisco Bosa Ojeda; Heidi Lehtola; Santiago Camacho-Freiere; Adriaan Kraaijeveld; Ylitalo Antti; Marco Boccalatte; Pierre Deharo; Inigo Lozano Martinez-Luengas; Bruno Scheller; Efthymia Varytimiadi; Raul Moreno; Giuseppe Uccello; Benjamin Faurie; Alejandro Gutierrez Barrios; Marek Milewski; Ewout Bruwiere; Pieter Smits; Bor Wilbert; Fortunato Scotto Di Uccio; Guido Parodi; Elvin Kedhi; Monica Verdoia

doi:10.1016/j.atherosclerosis.2021.06.926

Impact of SARS-CoV-2 positivity on clinical outcome among STEMI patients undergoing mechanical reperfusion: Insights from the ISACS STEMI COVID 19 registry

Giuseppe De Luca^*, Niels Debel, Miha Cercek, Lisette Okkels Jensen, Marija Vavlukis, Lucian Calmac, Tom Johnson, Gerard Rourai Ferrer, Vladimir Ganyukov, Wojtek Wojakowski, Tim Kinnaird, Clemens von Birgelen, Yves Cottin, Alexander IJsselmuiden, Bernardo Tuccillo, Francesco Versaci, Kees-Jan Royaards, Jurrien ten Berg, Mika Laine, Maurits DirksenMassimo Siviglia, Gianni Casella, Petr Kala, Jose Luis Diez Gil, Adrian Banning, Victor Becerra, Ciro De Simone, Andrea Santucci, Xavier Carrillo, Alessandra Scoccia, Giovanni Amoroso, Arnoud Wj van't Hof, Tomas Kovarnik, Grigorios Tsigkas, Julinda Mehilli, Gabriele Gabrielli, Xacobe Flores Rios, Nikola Bakraceski, Sebastien Levesque, Giuseppe Cirrincione, Vincenzo Guiducci, Michal Kidawa, Leonardo Spedicato, Lucia Marinucci, Peter Ludman, Filippo Zilio, Gennaro Galasso, Enrico Fabris, Maurizio Menichelli, Arturo Garcia-Touchard, Stephane Manzo, Gianluca Caiazzo, Jose Moreu, Juan Sanchis Fores, Luca Donazzan, Luigi Vignali, Rui Teles, Edouard Benit, Pierfrancesco Agostoni, Francisco Bosa Ojeda, Heidi Lehtola, Santiago Camacho-Freiere, Adriaan Kraaijeveld, Ylitalo Antti, Marco Boccalatte, Pierre Deharo, Inigo Lozano Martinez-Luengas, Bruno Scheller, Efthymia Varytimiadi, Raul Moreno, Giuseppe Uccello, Benjamin Faurie, Alejandro Gutierrez Barrios, Marek Milewski, Ewout Bruwiere, Pieter Smits, Bor Wilbert, Fortunato Scotto Di Uccio, Guido Parodi, Elvin Kedhi, Monica Verdoia

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background and aims: SARS-Cov-2 predisposes patients to thrombotic complications, due to excessive inflam-mation, 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 symbolscript 0.004) and heart failure (22.6% vs 10.6%, p symbolscript 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.

Original language	English
Pages (from-to)	48-54
Number of pages	7
Journal	Atherosclerosis
Volume	332
DOIs	https://doi.org/10.1016/j.atherosclerosis.2021.06.926
Publication status	Published - Sept 2021

Keywords

SARS-CoV-2
ST segment elevation myocardial infarction
Thrombosis(please add them)
ELEVATION MYOCARDIAL-INFARCTION
THROMBUS ASPIRATION
PRIMARY ANGIOPLASTY
METAANALYSIS
MORTALITY

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10.1016/j.atherosclerosis.2021.06.926

Cite this

De Luca, G., Debel, N., Cercek, M., Jensen, L. O., Vavlukis, M., Calmac, L., Johnson, T., Rourai Ferrer, G., Ganyukov, V., Wojakowski, W., Kinnaird, T., von Birgelen, C., Cottin, Y., IJsselmuiden, A., Tuccillo, B., Versaci, F., Royaards, K.-J., ten Berg, J., Laine, M., ... Verdoia, M. (2021). Impact of SARS-CoV-2 positivity on clinical outcome among STEMI patients undergoing mechanical reperfusion: Insights from the ISACS STEMI COVID 19 registry. Atherosclerosis, 332, 48-54. https://doi.org/10.1016/j.atherosclerosis.2021.06.926

@article{ce851afd2d0742c7acd0b45e6e2ee131,

title = "Impact of SARS-CoV-2 positivity on clinical outcome among STEMI patients undergoing mechanical reperfusion: Insights from the ISACS STEMI COVID 19 registry",

abstract = "Background and aims: SARS-Cov-2 predisposes patients to thrombotic complications, due to excessive inflam-mation, 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 symbolscript 0.004) and heart failure (22.6% vs 10.6%, p symbolscript 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.",

keywords = "SARS-CoV-2, ST segment elevation myocardial infarction, Thrombosis(please add them), ELEVATION MYOCARDIAL-INFARCTION, THROMBUS ASPIRATION, PRIMARY ANGIOPLASTY, METAANALYSIS, MORTALITY",

author = "{De Luca}, Giuseppe and Niels Debel and Miha Cercek and Jensen, {Lisette Okkels} and Marija Vavlukis and Lucian Calmac and Tom Johnson and {Rourai Ferrer}, Gerard and Vladimir Ganyukov and Wojtek Wojakowski and Tim Kinnaird and {von Birgelen}, Clemens and Yves Cottin and Alexander IJsselmuiden and Bernardo Tuccillo and Francesco Versaci and Kees-Jan Royaards and {ten Berg}, Jurrien and Mika Laine and Maurits Dirksen and Massimo Siviglia and Gianni Casella and Petr Kala and Gil, {Jose Luis Diez} and Adrian Banning and Victor Becerra and {De Simone}, Ciro and Andrea Santucci and Xavier Carrillo and Alessandra Scoccia and Giovanni Amoroso and {van't Hof}, {Arnoud Wj} and Tomas Kovarnik and Grigorios Tsigkas and Julinda Mehilli and Gabriele Gabrielli and Rios, {Xacobe Flores} and Nikola Bakraceski and Sebastien Levesque and Giuseppe Cirrincione and Vincenzo Guiducci and Michal Kidawa and Leonardo Spedicato and Lucia Marinucci and Peter Ludman and Filippo Zilio and Gennaro Galasso and Enrico Fabris and Maurizio Menichelli and Arturo Garcia-Touchard and Stephane Manzo and Gianluca Caiazzo and Jose Moreu and Fores, {Juan Sanchis} and Luca Donazzan and Luigi Vignali and Rui Teles and Edouard Benit and Pierfrancesco Agostoni and Ojeda, {Francisco Bosa} and Heidi Lehtola and Santiago Camacho-Freiere and Adriaan Kraaijeveld and Ylitalo Antti and Marco Boccalatte and Pierre Deharo and Martinez-Luengas, {Inigo Lozano} and Bruno Scheller and Efthymia Varytimiadi and Raul Moreno and Giuseppe Uccello and Benjamin Faurie and Barrios, {Alejandro Gutierrez} and Marek Milewski and Ewout Bruwiere and Pieter Smits and Bor Wilbert and {Di Uccio}, {Fortunato Scotto} and Guido Parodi and Elvin Kedhi and Monica Verdoia",

year = "2021",

month = sep,

doi = "10.1016/j.atherosclerosis.2021.06.926",

language = "English",

volume = "332",

pages = "48--54",

journal = "Atherosclerosis",

issn = "0021-9150",

publisher = "Elsevier Ireland Ltd",

}

De Luca, G, Debel, N, Cercek, M, Jensen, LO, Vavlukis, M, Calmac, L, Johnson, T, Rourai Ferrer, G, Ganyukov, V, Wojakowski, W, Kinnaird, T, von Birgelen, C, Cottin, Y, IJsselmuiden, A, Tuccillo, B, Versaci, F, Royaards, K-J, ten Berg, J, Laine, M, Dirksen, M, Siviglia, M, Casella, G, Kala, P, Gil, JLD, Banning, A, Becerra, V, De Simone, C, Santucci, A, Carrillo, X, Scoccia, A, Amoroso, G, van't Hof, AW, Kovarnik, T, Tsigkas, G, Mehilli, J, Gabrielli, G, Rios, XF, Bakraceski, N, Levesque, S, Cirrincione, G, Guiducci, V, Kidawa, M, Spedicato, L, Marinucci, L, Ludman, P, Zilio, F, Galasso, G, Fabris, E, Menichelli, M, Garcia-Touchard, A, Manzo, S, Caiazzo, G, Moreu, J, Fores, JS, Donazzan, L, Vignali, L, Teles, R, Benit, E, Agostoni, P, Ojeda, FB, Lehtola, H, Camacho-Freiere, S, Kraaijeveld, A, Antti, Y, Boccalatte, M, Deharo, P, Martinez-Luengas, IL, Scheller, B, Varytimiadi, E, Moreno, R, Uccello, G, Faurie, B, Barrios, AG, Milewski, M, Bruwiere, E, Smits, P, Wilbert, B, Di Uccio, FS, Parodi, G, Kedhi, E & Verdoia, M 2021, 'Impact of SARS-CoV-2 positivity on clinical outcome among STEMI patients undergoing mechanical reperfusion: Insights from the ISACS STEMI COVID 19 registry', Atherosclerosis, vol. 332, pp. 48-54. https://doi.org/10.1016/j.atherosclerosis.2021.06.926

TY - JOUR

T1 - Impact of SARS-CoV-2 positivity on clinical outcome among STEMI patients undergoing mechanical reperfusion

T2 - Insights from the ISACS STEMI COVID 19 registry

AU - De Luca, Giuseppe

AU - Debel, Niels

AU - Cercek, Miha

AU - Jensen, Lisette Okkels

AU - Vavlukis, Marija

AU - Calmac, Lucian

AU - Johnson, Tom

AU - Rourai Ferrer, Gerard

AU - Ganyukov, Vladimir

AU - Wojakowski, Wojtek

AU - Kinnaird, Tim

AU - von Birgelen, Clemens

AU - Cottin, Yves

AU - IJsselmuiden, Alexander

AU - Tuccillo, Bernardo

AU - Versaci, Francesco

AU - Royaards, Kees-Jan

AU - ten Berg, Jurrien

AU - Laine, Mika

AU - Dirksen, Maurits

AU - Siviglia, Massimo

AU - Casella, Gianni

AU - Kala, Petr

AU - Gil, Jose Luis Diez

AU - Banning, Adrian

AU - Becerra, Victor

AU - De Simone, Ciro

AU - Santucci, Andrea

AU - Carrillo, Xavier

AU - Scoccia, Alessandra

AU - Amoroso, Giovanni

AU - van't Hof, Arnoud Wj

AU - Kovarnik, Tomas

AU - Tsigkas, Grigorios

AU - Mehilli, Julinda

AU - Gabrielli, Gabriele

AU - Rios, Xacobe Flores

AU - Bakraceski, Nikola

AU - Levesque, Sebastien

AU - Cirrincione, Giuseppe

AU - Guiducci, Vincenzo

AU - Kidawa, Michal

AU - Spedicato, Leonardo

AU - Marinucci, Lucia

AU - Ludman, Peter

AU - Zilio, Filippo

AU - Galasso, Gennaro

AU - Fabris, Enrico

AU - Menichelli, Maurizio

AU - Garcia-Touchard, Arturo

AU - Manzo, Stephane

AU - Caiazzo, Gianluca

AU - Moreu, Jose

AU - Fores, Juan Sanchis

AU - Donazzan, Luca

AU - Vignali, Luigi

AU - Teles, Rui

AU - Benit, Edouard

AU - Agostoni, Pierfrancesco

AU - Ojeda, Francisco Bosa

AU - Lehtola, Heidi

AU - Camacho-Freiere, Santiago

AU - Kraaijeveld, Adriaan

AU - Antti, Ylitalo

AU - Boccalatte, Marco

AU - Deharo, Pierre

AU - Martinez-Luengas, Inigo Lozano

AU - Scheller, Bruno

AU - Varytimiadi, Efthymia

AU - Moreno, Raul

AU - Uccello, Giuseppe

AU - Faurie, Benjamin

AU - Barrios, Alejandro Gutierrez

AU - Milewski, Marek

AU - Bruwiere, Ewout

AU - Smits, Pieter

AU - Wilbert, Bor

AU - Di Uccio, Fortunato Scotto

AU - Parodi, Guido

AU - Kedhi, Elvin

AU - Verdoia, Monica

PY - 2021/9

Y1 - 2021/9

N2 - Background and aims: SARS-Cov-2 predisposes patients to thrombotic complications, due to excessive inflam-mation, 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 symbolscript 0.004) and heart failure (22.6% vs 10.6%, p symbolscript 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.

AB - Background and aims: SARS-Cov-2 predisposes patients to thrombotic complications, due to excessive inflam-mation, 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 symbolscript 0.004) and heart failure (22.6% vs 10.6%, p symbolscript 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.

KW - SARS-CoV-2

KW - ST segment elevation myocardial infarction

KW - Thrombosis(please add them)

KW - ELEVATION MYOCARDIAL-INFARCTION

KW - THROMBUS ASPIRATION

KW - PRIMARY ANGIOPLASTY

KW - METAANALYSIS

KW - MORTALITY

U2 - 10.1016/j.atherosclerosis.2021.06.926

DO - 10.1016/j.atherosclerosis.2021.06.926

M3 - Article

C2 - 34391035

SN - 0021-9150

VL - 332

SP - 48

EP - 54

JO - Atherosclerosis

JF - Atherosclerosis

ER -