What you need to know
Interventional cardiologists at Hackensack University Medical Center recently concluded a study that suggests that the mechanisms responsible for COVID-associated myocardial infarction (heart attack), may involve less extensive blockages of the blood vessels in the heart and less clotting of blood than is found in patients with heart attacks who do not have COVID-19.
Details about the study
The study, Acute Myocardial Infarction in the COVID Era: Extent of Coronary Artery Disease, Presence of Thrombus and MINOCA (myocardial infarction with nonobstructive coronary arteries), focused on how the arteries in the heart appeared when heart attack patients who had COVID-19 came to the hospital and compared them to those of patients with heart attacks a year earlier who did not have COVID.
The study compared patients with COVID-19 and heart attack who underwent heart catheterization at Hackensack University Medical Center during the first wave of the pandemic from March to June 2020 with a representative sample of patients with heart attacks treated during the same months in 2019, prior to the emergence of the virus. Heart catheterization is an interventional procedure used to diagnose and treat certain cardiovascular conditions.
The researchers analyzed the appearance of the heart arteries from the two groups of heart attack patients (first wave of COVID vs 2019) to ascertain any differences. Specifically, the patients’ arteries were analyzed for SYNTAX score, a grading method to determine the complexity and extent of blocked arteries; they also looked for the presence of clots and tallied the number of patients who were having heart attacks despite not having any visible blockages at all. The investigators who did this analysis were blinded to whether the individual patients were having heart attacks during the pandemic or the year prior.
During March to June 2020 (the index period), 1,289 patients with COVID-19 were hospitalized at Hackensack University Medical Center. The greatest difference between COVID patients having heart attacks during this period and those in 2019 was in patients having so called STEMIs, the largest and most dangerous types of heart attacks. SYNTAX scores were lower (score = 8) for patients with COVID versus the non-COVID patients in 2019 (score = 17). The presence of clot was also lower in the COVID group (33 percent versus 82 percent), while heart attack despite no blockage at all (MINOCA) was much more common in the index (COVID-19) group (37 percent) than the 6 percent in the baseline group (non-COVID).
“Our findings suggest that the mechanisms responsible for COVID-associated heart attacks may involve less extensive coronary artery disease and less clotting in major blood vessels. This may be a result of the increased demand for oxygen to the heart despite relatively little in the way of blocked arteries and may suggest the potential for a different approach in managing heart attacks in COVID patients.”Zoltan G. Turi, M.D., director, Cardiovascular Research, HUMC Heart and Vascular Hospital and the lead author of the study
The study was presented at the Society for Cardiovascular Angiography and Interventions 2021 Virtual Scientific Sessions on April 28 – May 1, 2021.
Click here to watch a video of Dr. Turi sharing his thoughts on the study.