BACKGROUND AND AIMS: SARS-Cov-2 predisposes patients to thrombotic complications, due to excessive inflammation, 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 = 0.004) and heart failure (22.6% vs 10.6%, p = 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.

AUSL IRCCS Reggio Emilia Italy

Azienda Ospedaliero Universitaria Ospedali Riuniti Trieste Italy

Azienda Ospedaliero Universitaria Sassari Italy

Cardiology Unit Virgen de la Victoria University Hospital; IBIMA Málaga Spain CIBERCV

Catholic University of Leuven Leuven Belgium

Center for Cardiovascular Diseases Ohrid Macedonia

Center Hospitalier Universitaire de Poitiers Poitiers University Hospital Poitiers France

Central Hospital of Medical University of Lodz Poland

Clinic Emergency Hospital of Bucharest Romania

Complexo Hospetaliero Universitario La Coruna La Coruna Spain

Department of Cardiology Medical Center Ljubljana Slovenia

Department of Cardiology Medisch Spectrum Twente Thoraxcentrum Twente Enschede the Netherlands

Division of Cardiology Amphia Hospital Breda the Netherlands

Division of Cardiology Attikon University Hospital Athens Greece

Division of Cardiology Azienda Ospedaliera Ospedali Riuniti Marche Nord Pesaro Italy

Division of Cardiology Azienda Ospedaliero Universitaria Maggiore della Carità Università del Piemonte Orientale Italy

Division of Cardiology Bristol Heart Institute University Hospitals Bristol NHSFT and University of Bristol Bristol UK

Division of Cardiology CHU Lariboisière AP HP Paris 7 University INSERM UMRS 942 France

Division of Cardiology CHU Timone Marseille France; Faculté de Médecine Aix Marseille Université Marseille France

Division of Cardiology Clinica Villa dei Fiori Acerra Italy

Division of Cardiology Clinical and Experimental Interventional Cardiology University of Saarland Germany

Division of Cardiology Complejo Hospitalario de Toledo Toledo Spain

Division of Cardiology Division of Cardiology Ospedali Riuniti Reggio Calabria Italy

Division of Cardiology Groupe Hospitalier Mutualiste de Grenoble France

Division of Cardiology Heart Centre Turku Finland

Division of Cardiology Helsinki University Central Hospital Finland

Division of Cardiology Hopital Erasme Universitè Libre de Bruxelles Belgium

Division of Cardiology Hospital Cabueñes Gijon Spain

Division of Cardiology Hospital Clinico Universitario de Valencia Spain

Division of Cardiology Hospital de Santa Cruz CHLO Carnaxide Portugal

Division of Cardiology Hospital la Paz Madrid Spain

Division of Cardiology Hospital Puerta de Hierro Majadahonda Spain

Division of Cardiology Hospital Puerta del Mar Cadiz Spain

Division of Cardiology Hospital Universitario de Canarias Santa Cruz de Tenerife Spain

Division of Cardiology Jessa Ziekenhuis Hasselt Belgium

Division of Cardiology Juan Ramon Jimenez Hospital Huelva Spain

Division of Cardiology Maasstad Ziekenhuis Rotterdam the Netherlands

Division of Cardiology Medical University of Silezia Katowice Poland

Division of Cardiology Medical University of Silezia Katowice Poland; Division of Cardiology Ospedale F Spaziani Frosinone Italy

Division of Cardiology Northwest Clinics Alkmaar the Netherlands

Division of Cardiology Odense Universitets Hospital Odense Denmark

Division of Cardiology Ospedale A Manzoni Lecco Italy

Division of Cardiology Ospedale Civico Arnas Palermo Italy

Division of Cardiology Ospedale degli Infermi ASL Biella Italy

Division of Cardiology Ospedale del Mare Napoli Italy

Division of Cardiology Ospedale F Spaziani Frosinone Italy

Division of Cardiology Ospedale G Moscati Aversa Italy

Division of Cardiology Ospedale Maggiore Bologna Italy

Division of Cardiology Ospedale S Maurizio Bolzano Italy

Division of Cardiology Ospedale San Giovanni di Dio e Ruggid'Aragona Salerno Italy

Division of Cardiology Ospedale Sant'Anna Ferrara Italy

Division of Cardiology Ospedale Santa Maria della Misericordia Udine Italy

Division of Cardiology Ospedale Santa Maria delle Grazie Pozzuoli Italy

Division of Cardiology Ospedale Santa Maria Goretti Latina Italy

Division of Cardiology Oulu University Hospital Finland

Division of Cardiology St Antonius Hospital Nieuwegein the Netherlands

Division of Cardiology State Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russia

Division of Cardiology UMC Utrecht the Netherlands

Division of Cardiology University Hospital Dijon France

Division of Cardiology University Hospital of Wales Cardiff UK

Division of Cardiology Ziekenhuis Netwerk Antwerpen Middelheim Antwerp Belgium

H Universitario y Politécnico La Fe Valencia Spain

Hospital Germans Triasi Pujol Badalona Spain

Interventional Cardiology Unit Azienda Ospedaliera Sanitaria Parma Italy

Interventional Cardiology Unit Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona Italy

Interventional Cardiology Unit Heart Disease Institute Hospital Universitari de Bellvitge Spain

Invasive Cardiology and Congenital Heart Disease Patras University Hospital Patras Greece

John Radcliffe Hospital Oxford UK

Mastricht University Medical Center the Netherlands

Onze Lieve Vrouwe Gasthuis Amsterdam the Netherlands

Ospedale Santa Chiara di Trento Italy

Ospedale Santa Maria della Misericordia Perugia Italy

University Clinic for Cardiology Medical Faculty Ss' Cyril and Methodius University Skopje Macedonia

University Hospital Birmingham Birmingham UK

University Hospital Brno Medical Faculty of Masaryk University Brno Czech Republic

University Hospital Munich Ludwig Maximilians University Munich Germany

University Hospital Prague Czech Republic

Comment In

Atherosclerosis. 2021 Nov;336:48. doi: 10.1016/j.atherosclerosis.2021.08.012. PubMed

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