COVID-19感染によるST上昇型心筋梗塞患者の特徴と管理の変化

Changes in characteristics and management among patients with ST-elevation myocardial infarction due to COVID-19 infection.

• Batric Popovic
• Jeanne Varlot
• Pierre Adrien Metzdorf
• Hélène Jeulin
• François Goehringer
• Edoardo Camenzind

抄録

目的:

一次経皮的冠動脈インターベンションを受けたコロナウイルス感染症（COVID-19）を有する ST-elevation Myocardial infarction（STEMI）患者の特徴と管理の変化を評価すること。

OBJECTIVES: To assess changes in characteristics and management among ST-elevation myocardial infarction (STEMI) patients with coronavirus disease (COVID-19) who underwent primary percutaneous coronary intervention.

方法:

我々の前向き単心研究では，COVID-19 発生時に PPCI を受けたすべての STEMI 患者を登録した（n = 83）．このコホートをまず以前のSTEMI患者コホート（2008年～2017年，n = 1,552例）と比較し，COVID-19非施行群（n = 72例）とCOVID-19施行群（n = 11例）に二分化した。

METHODS: Our prospective, monocentric study enrolled all STEMI patients who underwent PPCI during the COVID-19 outbreak (n = 83). This cohort was first compared with a previous cohort of STEMI patients (2008-2017, n = 1,552 patients) and was then dichotomized into a non-COVID-19 group (n = 72) and COVID-19 group (n = 11).

結果:

発生前と比較して、発生期間中の患者は高齢（59.6 ± 12.9 vs. 62.6 ± 12.2、p = 0.03）であり、ケアへのシークトゥケアが遅れていた（平均初発症状の遅れ-バルーン3.8 vs. 0.7.4 &#xB1;7.7、p&lt;.001）ため、院内死亡率が2倍高くなった（非COVID-19.4 vs. 3.3%）。8±3 vs. .7.4±7.7、p<.001）その結果、院内死亡率が2倍高くなった（非COVID-19 4.3％ vs. COVID-19 8.4％、p=0.07）。発生期間中に入院した 83 人の STEMI 患者のうち、11 人の患者が COVID-19 に感染していた。COVID-19群では炎症の生物学的マーカー（C反応性蛋白質：28±39 vs. 98±97mg/L、p = 0.04）、線溶（Dダイマー：804±1,500 vs. 3,128±2,458μg/L、p = 0.02）、抗リン脂質抗体が4例で高値を示した。この群では血管造影データにも違いがあり、血栓性心筋梗塞非動脈硬化性冠動脈閉塞症（MINOCA）が11例（1.4％対54.5％、p＜0.001）に認められ、術後遠位塞栓術の増加（30.6％対72.7％、p＝0.007）と関連していた。院内死亡率はCOVID-19群で有意に高かった（5.6％ vs. 27.3％、p = 0.016）。

RESULTS: In comparison with the pre-outbreak period, patients during the outbreak period were older (59.6 ± 12.9 vs. 62.6 ± 12.2, p = .03) with a delayed seek to care (mean delay first symptoms-balloon 3.8 ± 3 vs. .7.4 ± 7.7, p < .001) resulting in a two-fold higher in-hospital mortality (non COVID-19 4.3% vs. COVID-19 8.4%, p = .07). Among the 83 STEMI patients admitted during the outbreak period, 11 patients were infected by COVID-19. Higher biological markers of inflammation (C-reactive protein: 28 ± 39 vs. 98 ± 97 mg/L, p = .04), of fibrinolysis (D-dimer: 804 ± 1,500 vs. 3,128 ± 2,458 μg/L, p = .02), and antiphospholipid antibodies in four cases were observed in the COVID-19 group. In this group, angiographic data also differed: a thrombotic myocardial infarction nonatherosclerotic coronary occlusion (MINOCA) was observed in 11 cases (1.4% vs. 54.5%, p < .001) and associated with higher post-procedure distal embolization (30.6% vs. 72.7%, p = .007). The in hospital mortality was significantly higher in the COVID-19 group (5.6% vs. 27.3%, p = .016).

結論:

COVID-19の発生は、COVID-19を有するSTEMI患者の病因発生と治療管理における深い変化を示唆している。この特定の集団における全身性炎症および高凝固性の早期および長期転帰への影響が検証されている。

CONCLUSION: The COVID-19 outbreak implies deep changes in the etiopathogenesis and therapeutic management of STEMI patients with COVID-19. The impact on early and long-term outcomes of systemic inflammation and hypercoagulability in this specific population is warranted.

© 2020 Wiley Periodicals LLC.