April 30, 2021
Data to be presented at Society for Cardiovascular Angiography and Interventions 2021 Virtual Scientific Sessions
Hackensack, NJ, April 30, 2021 – Interventional cardiologists at Hackensack University Medical Center are presenting new research at a leading cardiology meeting this week 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. The analysis is being presented at the Society for Cardiovascular Angiography and Interventions 2021 Virtual Scientific Sessions this week (April 28 – May 1, 2021).
“The first wave of the COVID-19 pandemic last year caused a large reduction in heart catheterizations due to reluctance of patients to come to the hospital because they were concerned about infectious risk,” said Zoltan G. Turi, M.D., Director, Cardiovascular Research, HUMC Heart and Vascular Hospital and the lead author of the study, Acute Myocardial Infarction in the COVID Era: Extent of Coronary Artery Disease, Presence of Thrombus and MINOCA (myocardial infarction with nonobstructive coronary arteries).“When patients did come to the hospital, they often delayed calling ambulances, which was unfortunate because our best chance to save lives and preserve heart function is to bring these patients to the heart catheterization laboratory as early as possible and open up any blocked arteries. Our study focused on just how the arteries in the heart did appear when heart attack patients who had COVID-19 did come to the hospital and compared them to those of patients with heart attacks a year earlier who of course did not have COVID.”
There are a number of ways in which 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 the buildup of cholesterol in the wall of arteries that supply blood, oxygen and nutrients to the heart.1
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.
Heart catheterization is an interventional procedure used to diagnose and treat certain cardiovascular conditions. During catheterization, a long, thin tube called a catheter is inserted into an artery or vein in the leg or arm and threaded through blood vessels to the heart. 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, a grading method 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.
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 so called STEMIs, the largest and most dangerous types of heart attacks. 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 versus 82 percent), while heart attack despite no blockage at all (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.”