Microvascular Dysfunction in COVID-19 Patients with Acute Coronary Syndrome

Erol Kalender; Gunes Melike Dogan; Kudret Keskin; Serhat Sigirci; Mutlu Cagan Sumerkan; Ozgur Selim Ser; Omer Alyan

doi:10.14744/SEMB.2023.92074

Microvascular Dysfunction in COVID-19 Patients with Acute Coronary Syndrome

Sisli Etfal Hastan Tip Bul. 2023 Sep 29;57(3):367-373. doi: 10.14744/SEMB.2023.92074. eCollection 2023.

Authors

Erol Kalender¹, Gunes Melike Dogan¹, Kudret Keskin¹, Serhat Sigirci¹, Mutlu Cagan Sumerkan¹, Ozgur Selim Ser¹, Omer Alyan¹

Affiliation

¹ Department of Cardiology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye.

Abstract

Objective: Coronavirus disease 2019 (COVID-19) is considered to deteriorate endothelial function through hyperinflammation. We aimed to investigate microvascular dysfunction using the angiographic parameters thrombolysis in myocardial infarction frame count (TFC) and myocardial blush grade (MBG), in COVID-19 patients with acute coronary syndrome (ACS).

Methods: One hundred and sixty-five patients presented with ACS (62.4% ST elevated myocardial infarction) and underwent percutaneous coronary intervention between March 1 and June 30, 2020, were enrolled in the study. The polymerase chain reaction test was performed in case of suggestive symptoms or typical computerized tomography findings.

Results: Twenty-six patients (15.7%) were tested positive for COVID-19. Significantly higher values were observed in TFC in patients with COVID-19 (p<0.001), whereas COVID-19 patients had significantly lower MBGs (Grade 0 and 1) (p<0.001). Peak troponin-I value was also higher in the COVID-19 group (27335 vs. 15959 ng/dL, p=0.006). Mortality risk was higher in COVID-19 patients (38.4% vs. 7.2%, p<0.001). TFC and ejection fraction may predict in-hospital mortality among COVID-19 patients with ACS according to logistic regression results. In correlation analysis, TFC correlated positively with C-reactive protein (r=0.340, p<0.001) and peak troponin-I value (r=0.369, p<0.001).

Conclusion: COVID-19 is associated with slow coronary flow and microvascular impairment in ACS.

Keywords: Acute myocardial infarction; COVID-19; Myocardial blush grade; Thrombolysis in myocardial infarction flow grade; Thrombolysis in myocardial infarction frame count.