Med Bull Sisli Etfal Hosp. 2023; 57(3): 367-373 | DOI: 10.14744/SEMB.2023.92074

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

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

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Akut Koroner Sendromu Olan COVID-19 Hastalarýnda Mikrovasküler Disfonksiyon

Erol Kalender, Gunes Melike Dogan, Kudret Keskin, Serhat Sigirci, Mutlu Cagan Sumerkan, Ozgur Selim Ser, Omer Alyan
Türkiye Saðlýk Bilimleri Üniversitesi, Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi, Kardiyoloji Kliniði, Ýstanbul

Amaç: Koronavirüs hastalýðýnýn (COVID-19) hiperinflamasyon yoluyla endotel fonksiyonunda bozulmaya neden olduðu düþünülmektedir. Bu çalýþmada, akut koroner sendromu olan COVID-19 hastalarýnda anjiyografik parametrelerden TIMI frame sayýsý (TFC) ve miyokardiyal boyanma derecesini (MBG) kullanarak mikrovasküler disfonksiyonu araþtýrmayý amaçladýk.
Gereç ve Yöntemler: 1 Mart - 30 Haziran 2020 tarihleri arasýnda akut koroner sendromla (%62,4’ü ST elevasyonlu miyokard enfarktüsü) baþvurarak perkütan koroner giriþim uygulanan yüz altmýþ beþ hasta çalýþmaya dahil edildi. COVID-19’u düþündüren semptomlarý veya tipik bilgisayarlý tomografi bulgularý olmasý durumunda hastalara polimeraz zincir reaksiyonu (PCR) testi yapýldý.
Bulgular: Yirmi altý hastada (%15,7) COVID-19 testi pozitif saptandý. COVID -19 hastalarý anlamlý olarak daha düþük MBG’ye (0 ve 1. derece) sahipken (p<0.001), TFC deðerleriyse anlamlý olarak daha yüksek saptandý (p<0.001). Tepe troponin-I deðeri de COVID-19 grubunda daha yüksek bulundu (27335’e karþý15959 ng/dl, p=0.006). Mortalite riski COVID-19 hastalarýnda daha yüksekti (%38,4’e karþý %7,2, p<0.001). Lojistik regresyon analizi sonuçlarýna göre; TFC ve ejeksiyon fraksiyonu, akut koroner sendromu olan COVID-19 hastalarýnda hastane içi mortaliteyi öngördürebilir. Korelasyon analizinde; TFC’nin, C-reaktif protein (CRP) (r=0.340, p<0.001) ve tepe troponin-I deðeriyle (r=0.369, p<0.001) pozitif korele olduðu saptandý.
Sonuç: COVID-19, akut koroner sendromda koroner yavaþ akým ve mikrovasküler bozulmayla iliþkilidir. (SETB-2022-09-206)

Anahtar Kelimeler: Akut miyokard enfarktüsü, COVID-19, miyokardiyal boyanma derecesi, TIMI akým derecesi, TIMI frame sayýsý

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