COVID-19 as an independent predictor of aspiration thrombectomy in STEMI. National data from the ORPKI register in the years 2020-2022.

INTRODUCTION

Coronavirus disease 2019 (COVID-19) exacerbates intravascular thrombosis that occurs in the coronary artery in ST-elevation myocardial infarction (STEMI).

AIM

To analyze the impact of COVID-19 on the application and effect of thrombectomy in STEMI patients.

MATERIAL AND METHODS

29915 STEMI patients were analyzed, of whom 3139 (10.5%) underwent thrombectomy. COVID-19 (+) was reported in 311 (10.8%). The clinical characteristics and management of STEMI in COVID-19 (+) and COVID-19 (-) patients were compared. A multivariable logistic regression analysis was performed in search of factors influencing thrombectomy.

RESULTS

COVID-19 (+) patients had higher Killip class (IV class; = 33 (12.31%) vs. = 138 (5.84%); < 0.0001) and cardiac arrest at baseline was more frequent in this group ( = 25 (8.04%) vs. = 137 (4.84%); = 0.016). Thrombolysis in myocardial infarction (TIMI) 3 after percutaneous coronary intervention was less frequent ( = 248 (80.52%) vs. = 2388 (87.19%); = 0.001) in the COVID-19 (-) group. Periprocedural mortality was similar in both groups ( = 28 (0.99%) vs. = 4 (1.29%); = 0.622). In multivariable regression analysis COVID-19 increased the risk of thrombectomy (OR = 1.23; 97.5% CI: 1.05-1.43; = 0.001).

CONCLUSIONS

STEMI patients undergoing aspiration thrombectomy who were COVID-19 (+) were more likely to be in a severe clinical condition (higher Killip class, more frequent cardiac arrest before the procedure) than COVID-19 (-) patients. Despite more intensive antiplatelet and anticoagulant treatment, PCI procedures were less likely to result in an optimal TIMI 3 effect. COVID-19 is an independent strong predictor of patient qualification for aspiration thrombectomy in STEMI.