Clinical and laboratory features of acute myocardial infarction with elevation of the ST segment of the electrocardiogram, which developed against the background of COVID-19

Objectives . To evaluate the clinical, laboratory, and long-term outcomes of patients with acute myocardial infarction (MI) and ST elevation on the electrocardiogram (STEMI), which occurred during or after COVID-19 infection. Material and methods . A prospective cohort study included 60 participants, matched by age, gender, and the Charlson Comorbidity Index. The participants were divided into three groups of 20: the study group, which included patients with STEMI and COVID-19; a comparison group of patients with STEMI but without COVID-19; and a third comparison group consisting of patients with COVID-19 but without STEMI. During hospitalization, the clinical presentation of STEMI and COVID-19 was analyzed, as well as laboratory, instrumental data, and anamnesis. Additionally, a genetic study was conducted to examine polymorphisms in the SERPINE1, ITGB3, and ITGA2 genes. Residual platelet activity was assessed, and long-term follow-up was conducted after hospital discharge. Results. Patients with identified COVID-19, regardless of STEMI, more frequently exhibited symptoms of this infectious disease. Patients with STEMI, regardless of the presence of COVID-19, had significantly more chest pain and elevated troponin I levels upon admission to the hospital. The groups of patients with STEMI did not diff er in key angiographic characteristics and technical aspects of performing percutaneous coronary intervention; however, in the COVID-19 group, the “symptom-balloon” time was significantly longer — 590 (340 ÷ 870) minutes compared to 305 (179 ÷ 390) minutes in the group without COVID-19, p < 0.001. Platelet aggregation with ADP, adrenaline, and collagen was higher in patients with COVID-19, including those in the STEMI group, compared to the STEMI group without COVID-19, p < 0.001. Patients with STEMI and COVID-19 required a longer hospital stay — 11 (9.5 ÷ 16.5) days compared to 9.5 (7 ÷ 13.5) days in the COVID-19 group without STEMI and 7 (7 ÷ 8) days in patients with STEMI without COVID-19, p < 0.001. No adverse cardiovascular events were observed in the long term in patients without COVID-19, whereas in the STEMI and COVID-19 group, there were 5 fatalities recorded and 4 in the group with COVID-19 without STEMI, as well as 4 cases of non-fatal myocardial infarction in the STEMI and COVID-19 group and 1 case in the group with COVID-19 without STEMI, p = 0.032. Conclusions . The mixed clinical picture of the infectious disease caused by COVID-19 and myocardial infarction may influence an increase in the time from symptom onset to reperfusion therapy, overall hospitalization duration, and worse long-term outcomes such as non-fatal myocardial infarctions and death.