New Hackensack University Medical Center Research Suggests Potential for Different Approach to Managing Heart Attack in Patients with COVID-19
Study shows that heart attack in COVID-19 patients involves less extensive coronary artery disease and blood clots than seen in heart attack patients without COVID-19
Interventional cardiologists at Hackensack University Medical Center presented new research at the Society for Cardiovascular Angiography and Interventions 2021 Virtual Scientific Sessions in April 2021 suggesting that the mechanisms responsible for COVID-associated myocardial infarction (heart attack) may involve less extensive blockages of the blood vessels in the heart and less clotting of blood than is found in patients with heart attacks who do not have COVID-19.
“Our study focused on how the arteries in the heart appeared when heart attack patients who had COVID-19 came to the hospital and compared them to those of patients who had heart attacks a year earlier, who of course did not have COVID,” said Zoltan G. Turi, M.D., Director, Cardiovascular Research, HUMC Heart and Vascular Hospital.
Dr. Turi is lead author of the study, titled “Acute Myocardial Infarction in the COVID Era: Extent of Coronary Artery Disease, Presence of Thrombus and MINOCA (myocardial infarction with nonobstructive coronary arteries).”
Comparing Patients with Heart Attack and COVID-19 vs. Patients with Heart Attack Only
According to Dr. Turi, there are a number of ways coronavirus can cause damage to heart muscle, including disrupting the balance between the available supply of blood going to the heart and the need for the oxygen supplied by the blood. Most patients with heart attacks have blockages in the heart’s major blood vessels, usually caused by atherosclerosis.
The study compared patients with COVID-19 and heart attack who underwent heart catheterization at Hackensack University Medical Center during the first wave of the pandemic from March to June 2020 with a representative sample of patients with heart attacks treated during the same months in 2019, prior to the emergence of the virus.
The researchers analyzed the appearance of the heart arteries from the two groups of heart attack patients (first wave of COVID vs 2019) to ascertain any differences. Specifically, the patients’ arteries were analyzed for SYNTAX score to determine the complexity and extent of blocked arteries. They also looked for the presence of clots and tallied the number of patients who were having heart attacks despite not having any visible blockages at all. The investigators who did this analysis were blinded to whether the individual patients were having heart attacks during the pandemic or the year prior.
COVID-Associated Heart Attack Involved Less CAD, Fewer Clots
During March to June 2020 (the index period), 1,289 patients with COVID-19 were hospitalized at Hackensack University Medical Center. The greatest difference between COVID patients having heart attacks during this period and those in 2019 was in patients having STEMIs. SYNTAX scores were lower (score = 8) for patients with COVID versus the non-COVID patients in 2019 (score = 17). The presence of clot was also lower in the COVID group (33 percent vs 82 percent), while myocardial infarction with non-obstructive coronary arteries (MINOCA) was much more common in the index (COVID-19) group (37 percent) than the 6 percent in the baseline group (non-COVID).
“Our findings suggest that the mechanisms responsible for COVID-associated heart attacks may involve less extensive coronary artery disease and less clotting in major blood vessels,” said Dr. Turi. “This may be a result of the increased demand for oxygen to the heart despite relatively little in the way of blocked arteries and may suggest the potential for a different approach in managing heart attacks in COVID patients.”