key: cord-0926329-0all46vs
authors: Cammann, Victoria L.; Szawan, Konrad A.; D’Ascenzo, Fabrizio; Gili, Sebastiano; Dreiding, Sara; Würdinger, Michael; Manka, Robert; Stähli, Barbara E.; Holy, Erik W.; Siegrist, Patrick; Jakob, Philipp; Meyer, Philippe; Iannaccone, Mario; Di Simone, Emanuela; Secco, Gioel Gabrio; Saccocci, Matteo; Bettari, Luca; Ielasi, Alfonso; Tespili, Maurizio; Quadri, Giorgio; Varbella, Ferdinando; Raposeiras-Roubin, Sergio; Abu-Assi, Emad; Mancone, Massimo; Sardella, Gennaro; Infusino, Fabio; Fedele, Francesco; Patti, Giuseppe; Mennuni, Marco; Rognoni, Andrea; Bollati, Mario; Olivotti, Luca; Cordone, Stefano; Carugo, Stefano; Barbieri, Lucia; Gaido, Luca; Giammaria, Massimo; Gambino, Alfonso; D’Amico, Maurizio; Galluzzo, Alessandro; Ugo, Fabrizio; Trabattoni, Daniela; De Filippo, Ovidio; De Ferrari, Gaetano Maria; Vecchione, Carmine; Citro, Rodolfo; Ghadri, Jelena R.; Templin, Christian
title: Outcomes of acute coronary syndromes in coronavirus disease 2019
date: 2020-09-19
journal: Clin Res Cardiol
DOI: 10.1007/s00392-020-01742-6
sha: f580f5fb86ad0ce0e68dd59a4f682f19d4ff994c
doc_id: 926329
cord_uid: 0all46vs

nan

COVID-19 positive ACS patients were more likely to present with dyspnea (51.1% vs. 19.7%; P < 0.001) and arterial hypertension (80.0% vs. 51.3%; P = 0.002), while other patients' characteristics were largely comparable to COVID-19 negative ACS patients (Table 1) . Of note, inhospital mortality was more than 3 times higher in COVID-19 positive ACS patients than in COVID-19 negative ACS patients (27.3% vs. 7.9%; P = 0.004, Table 1 ). Furthermore, when stratifying patients according to the presence or absence of ST-segment elevation, COVID-19 positive patients with STE-ACS had higher mortality rates compared to COVID-19 negative STE-ACS patients (33.3% vs. 9.3%; P = 0.024) and also COVID-19 positive patients with NSTE-ACS showed numerically higher mortality rates compared to COVID-19 negative NSTE-ACS patients (17.6% vs. 6.1%; P = 0.32). Importantly, 9 out of 12 (75%) deceased COVID-19 positive ACS patients had involvement of multiple organ systems in addition to cardiac manifestations, thus indicating a systemic vascular damage. In comparison to recovered COVID-19 positive ACS patients, deceased COVID-19 positive ACS patients had markedly elevated troponin values (factor increase in upper limit of the normal (ULN): 65.00 vs. 323.00; P = 0.014) and brain natriuretic peptide values (factor increase in ULN: 2.00 vs. 113.23; P = 0.023) accompanied by severely depressed left ventricular ejection fraction (45.3 ± 10.3% vs. 34.3 ± 9.5%; P = 0.003) suggesting incremental SARS-CoV-2 related myocardial injury further aggravating ACS related heart failure.

The relatively low frequency of ACS in COVID-19 may in part explained by the fact that not all COVID-19 positive patients who exhibit ST-segment elevation undergo coronary angiography [3] . The concomitant occurrence of COVID-19 and ACS might be responsible for the increased mortality. Pathophysiological mechanisms underlying COVID-19 related ACS events are unknown but might include acute plaque rupture or erosion facilitated by systemic inflammation, microvascular thrombosis due to hypercoagulability, and/or endothelial dysfunction [4] . The latter is known to play a key role in arterial hypertension and thrombosis and has recently been associated with COVID-19 [5] . In this respect, endotheliitis in COVID-19 might affect various vascular beds thereby increasing the susceptibility for thromboembolic and septic complications or multi-organ-failure [5] . Thus, myocardial ischemia due to ACS might be even aggravated by COVID-19 induced generalized microvascular dysfunction and systemic vascular damage leading to severe heart failure with unfavorable outcomes. Therefore, in addition to a guideline-directed ACS management, therapies to improve endothelial dysfunction might be considered in patients with COVID-19.

Funding None.

Conflict of interest The authors report no conflicts of interest. 

Clinical features of patients infected with 2019 novel coronavirus in Wuhan

Association of Cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan

ST-segment elevation in patients with Covid-19-a case series

Potential effects of coronaviruses on the cardiovascular system: a review

Endothelial cell infection and endotheliitis in COVID-19