Comprehensive Evaluation of Coronary Pathophysiology in the Context of COVID-19: Clinical Insights and Angiographic Assessment.

Background: The COVID-19 pandemic has severely impacted cardiology, with myocardial injury and new-onset cardiac dysfunction observed even without respiratory symptoms. The Aim of the study aimed to evaluate angiographic and clinical characteristics of COVID-19-positive patients who were presented with acute coronary syndrome. Method: This retrospective case-control study involved 80 COVID-19-positive patients with acute coronary syndrome who underwent angiography, compared to matched COVID-19-negative controls. Conducted at King Saud Medical City, Riyadh, between June 2021 and July 2022. It included angiographic, echocardiographic and laboratory evaluations. Results: 80 (1.6%) of 5134 COVID-19 patients underwent coronary angiography for coronary artery disease over 14 months. The COVID-19-positive and control groups were primarily male (78.75% vs. 75%) and had similar mean ages (57.1±10.86 vs. 55.93±10 years). The control group had higher rates of diabetes (81.3% vs. 66.3%) and hypertension (85% vs. 57.5%), while the COVID-19 group had higher smoking rates, STEMI (50% vs. 26.3%), and elevated D-dimer, C reactive protein (CRP), and cardiac troponins. COVID-19 patients had more ventricular thrombus (15% vs. 3.75%), RV dilation (36.25% vs. 11.25%), and pulmonary hypertension (50% vs. 26.3%). COVID-19 patients had more single-vessel disease (35% vs. 17.5%), and controls had more three-vessel disease (47.5% vs 22.5%). The COVID-19 group also used more thrombus aspiration (17.5% vs. 5%) and glycoprotein IIb/IIIa inhibitors (37.5% vs. 6.33%). Conclusions: The findings of this study show that COVID-19 increases cardiovascular injury. Even if the cause is unknown, cardiac injury must be detected quickly. ACS, including STEMI, can kill if not diagnosed and treated immediately. All COVID-19-positive patients with chest pain should be treated with a high index of suspicion due to the risk of coronary thrombosis due to hypercoagulability.