Authors
Vardanyan A.G., Teplova N.V., Evsikov E.M., Dzheksembekov A.G., Chobanyan M.A.
Pirogov Russian National Research Medical University, Moscow
Abstract
Background. Following infection with coronavirus-2 (SARS-CoV-2), the risk of both acute non-ischemic myocardial injury and acute myocardial infarction may increase, particularly type 2 myocardial infarction. Timely interventional coronary revascularization after thrombosis does not always result in restoration of coronary artery patency due to re-thrombosis and inflammatory processes. A number of studies conducted in Europe and the United States involving coronary angiography and percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) and COVID-19 confirm the validity of pathophysiological concepts regarding the inflammatory and thrombotic nature of coronary and myocardial injury.
Objective. To compare the frequency of use of coronary stents with different drug-eluting coatings in selected groups of patients with acute myocardial infarction, COVID-19 infection, and viral pneumonia depending on in-hospital outcomes: discharge or death due to disease complications.
Materials and methods. The study included 83 patients aged 45–85 years admitted on an emergency basis with a diagnosis of acute myocardial infarction (AMI) or unstable angina combined with viral pneumonia (or acute gas exchange disorders) and COVID-19. All patients with AMI underwent pulse oximetry, complete blood count, biochemical blood analysis, urinalysis, coagulation profile, multislice computed tomography (MSCT) of the lungs, and COVID-19 diagnosis using polymerase chain reaction (PCR) testing of oropharyngeal and nasopharyngeal swabs. Renal excretory function was dynamically assessed by changes in serum creatinine levels. Clinical, electrocardiographic, angiographic (coronary angiography), and biochemical (enzymatic) criteria were used to diagnose acute coronary syndrome and myocardial infarction with and without ST-segment elevation. Contrast coronary angiography (CAG) was performed using Artis Zee (Siemens Healthineers, Germany) and Azurion 3 (Philips, Netherlands) angiographic systems. CAG and transluminal balloon coronary angioplasty (TBCA) were performed according to the method of Elchaninoff et al. via radial access, less frequently via femoral arterial access. Mechanical recanalization, balloon angioplasty, and coronary artery stenting using balloon dilation were performed in 59 patients.
Results. Contrast coronary angiography revealed more severe atherosclerotic involvement of the coronary bed in deceased patients with ACS and COVID-19, predominantly affecting the left anterior descending coronary artery. The frequency of coronary occlusion was generally similar in deceased and surviving patients, averaging 58% and 46%, respectively, with acute forms predominating (83–92% of all cases). Implantation of coronary stents coated with sirolimus during PCI was associated with a significantly higher incidence of fatal outcomes in the group of deceased patients (by an average of 25.3%). In contrast, the use of zotarolimus-eluting stents demonstrated a significant positive trend toward improved survival in patients with AMI and COVID-19 following coronary intervention.
Conclusions. Analysis of the use of coronary stents with different antiproliferative drug-eluting coatings in patients with AMI complicated by COVID-19 and viral pneumonia during primary PCI revealed an association between sirolimus-eluting stents and unfavorable in-hospital outcomes. Conversely, a positive survival trend was observed following coronary revascularization with zotarolimus-eluting stents.
Keywords: acute myocardial infarction, COVID-19, pneumonia, coronary stenting, drug-eluting coating.
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