Journal Article

SARS-COV-2 colonizes coronary thrombus and impairs heart microcirculation bed in asymptomatic SARS-CoV-2 positive subjects with acute myocardial infarction

Signioriello, Giuseppe, Paolisso, Giuseppe, Trotta, Maria Consiglia, Pignataro, Danilo, Mauro, Ciro, Sasso, Ferdinando Carlo, Cesaro, Arturo, Galdiero, Massimiliano, Rizzo, Maria Rosaria, Balestrieri, Maria Luisa, Marfella, Raffaele, Barbieri, Michelangela, Scisciola, Lucia, Galdiero, Marilena, Palomba, Luciana, Barbato, Emanuele, Sardu, Celestino, Minicucci, Fabio, D’Amico, Michele, D’Onofrio, Nunzia, Turriziani, Fabrizio, Paolisso, Pasquale, Calabrò, Paolo

2021

Overview

Background The viral load of asymptomatic SAR-COV-2 positive (ASAP) persons has been equal to that of symptomatic patients. On the other hand, there are no reports of ST-elevation myocardial infarction (STEMI) outcomes in ASAP patients. Therefore, we evaluated thrombus burden and thrombus viral load and their impact on microvascular bed perfusion in the infarct area (myocardial blush grade, MBG) in ASAP compared to SARS-COV-2 negative (SANE) STEMI patients. Methods This was an observational study of 46 ASAP, and 130 SANE patients admitted with confirmed STEMI treated with primary percutaneous coronary intervention and thrombus aspiration. The primary endpoints were thrombus dimension + thrombus viral load effects on MBG after PPCI. The secondary endpoints during hospitalization were major adverse cardiovascular events (MACEs). MACEs are defined as a composite of cardiovascular death, nonfatal acute AMI, and heart failure during hospitalization. Results In the study population, ASAP vs. SANE showed a significant greater use of GP IIb/IIIa inhibitors and of heparin ( p  < 0.05), and a higher thrombus grade 5 and thrombus dimensions ( p  < 0.05). Interestingly, ASAP vs. SANE patients had lower MBG and left ventricular function ( p  < 0.001), and 39 (84.9%) of ASAP patients had thrombus specimens positive for SARS-COV-2. After PPCI, a MBG 2–3 was present in only 26.1% of ASAP vs. 97.7% of SANE STEMI patients ( p  < 0.001). Notably, death and nonfatal AMI were higher in ASAP vs. SANE patients ( p  < 0.05). Finally, in ASAP STEMI patients the thrombus viral load was a significant determinant of thrombus dimension independently of risk factors ( p  < 0.005). Thus, multiple logistic regression analyses evidenced that thrombus SARS-CoV-2 infection and dimension were significant predictors of poorer MBG in STEMI patients. Intriguingly, in ASAP patients the female vs. male had higher thrombus viral load (15.53 ± 4.5 vs. 30.25 ± 5.51 CT; p  < 0.001), and thrombus dimension (4.62 ± 0.44 vs 4.00 ± 1.28 mm 2 ; p  < 0.001). ASAP vs. SANE patients had a significantly lower in-hospital survival for MACE following PPCI ( p  < 0.001). Conclusions In ASAP patients presenting with STEMI, there is strong evidence towards higher thrombus viral load, dimension, and poorer MBG. These data support the need to reconsider ASAP status as a risk factor that may worsen STEMI outcomes.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Analysis of Variance / Anticoagulants / Asymptomatic Infections - epidemiology / Asymptomatic SARS-COV-2 patients / Blood clots / Care and treatment / Cohort Studies / Coronary Angiography - methods / Coronary Thrombosis - epidemiology / Coronary Thrombosis - virology / Coronaviruses / COVID-19 / COVID-19 - complications / COVID-19 - epidemiology / Critical care / Critical Care Medicine / Development and progression / Echocardiography - methods / Emergency Medicine / Female / Heart - physiopathology / Heart attack / Heart attacks / Humans / Intensive / Intracoronary thrombus / Kaplan-Meier Estimate / Laboratories / Male / Medical imaging / Medicine / Medicine & Public Health / Microcirculation - physiology / Middle Aged / Myocardial Infarction - epidemiology / Myocardial Infarction - physiopathology / Prognosis / SARS-COV-2 / Severe acute respiratory syndrome coronavirus 2 / STEMI / Thrombus viral load