Ifthikar Syed, Savoj Javad, Singh Harjeet, Hu Patrick
Cardiology, HCA Healthcare Riverside, Riverside, USA.
Internal Medicine, HCA Healthcare Riverside, Riverside, USA.
Cureus. 2023 Aug 15;15(8):e43539. doi: 10.7759/cureus.43539. eCollection 2023 Aug.
The capacity of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to wreak havoc on the inflammatory and coagulation pathways via the cytokine storm has led to over 6.3 million fatalities globally. Based on recent data, the mechanism predominately involves the formation of microvascular thrombosis when pertaining to cardiovascular disease. However, a subset of coronavirus disease-2019 (COVID-19)-positive patients present emergently with acute ST-elevation myocardial infarction (STEMI) are found to have severe epicardial thrombosis which is refractory to traditional coronary revascularization. We have noted mortality in these patients presenting to our facility to be as high as 90% and all angiographically confirmed to have thrombus which was refractory to traditional therapy. We present a case series of COVID-19-positive patients presenting with STEMI found to have epicardial thrombus who were treated with different traditional STEMI therapies but with fatal outcomes. Other possible techniques including mechanical thrombectomy, optimizing traditional and nontraditional anticoagulation therapy with the use of early hemodynamic support may prove more efficacious to destroy thrombus and potentially improve mortality.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）通过细胞因子风暴对炎症和凝血途径造成破坏的能力已导致全球超过630万人死亡。根据最近的数据，当涉及心血管疾病时，该机制主要涉及微血管血栓形成。然而，一部分新型冠状病毒肺炎（COVID-19）阳性患者紧急出现急性ST段抬高型心肌梗死（STEMI），被发现有严重的心外膜血栓形成，这对传统的冠状动脉血运重建治疗无效。我们注意到，在我们机构就诊的这些患者的死亡率高达90%，所有血管造影均证实有血栓，且对传统治疗无效。我们报告了一系列COVID-19阳性且出现STEMI并被发现有心外膜血栓的患者病例，他们接受了不同的传统STEMI治疗，但均预后不良。其他可能的技术，包括机械取栓术，在早期血流动力学支持下优化传统和非传统抗凝治疗，可能被证明对破坏血栓更有效，并有可能降低死亡率。
