Evaluation of Percutaneous Coronary Intervention Results in Patients With Acute Coronary Syndrome After COVID-19

Aim        To compare the results of primary percutaneous coronary intervention (PCI) for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in patients who recently recovered from COVID-19 with those not previously infected with SARS-CoV-2; to establish prognostic criteria for PCI complications, including stent thrombosis and restenosis (ST and SR) and progression of ischemic heart disease, and to determine ways to prevent them.

Material and methods         In 2021, middle-aged patients admitted to the Baku Central Clinical Hospital with a diagnosis of acute coronary syndrome who underwent urgent myocardial revascularization using percutaneous balloon angioplasty of the occluded coronary artery (CA) with implantation of a second-generation intracoronary drug-eluting stent were divided into two observation groups: the main group of 123 patients who had COVID-19 in the previous 6 months, and the control group of 112 patients who were not previously infected with SARS-CoV-2. The immediate results of PCI were assessed according to the TIMI scale; complications were assessed both clinically, by the incidence of severe complications (major adverse cardiovascular events, MACE), and angiographically, by the incidence of early and late ST and SR, and de novo stenosis that developed during the two-year observation period. The results of PCI were compared with the concentration of inflammatory biomarkers (high-sensitivity C-reactive protein, hs-CRP) and thrombosis (D-dimer) in order to assess their possible prognostic potential for negative outcomes of PCI after COVID-19.

Results    After COVID-19, the incidence of ST and SR, repeat myocardial revascularization, MACE, and de novo stenosis over the two-year follow-up period was higher than in patients with NSTE-ACS previously not infected with SARS-CoV-2. The D-dimer and hs-CRP levels showed a prognostic potential for negative outcomes of coronary stenting after COVID-19. Thus, early STs were associated with hypercoagulation (D-dimer ≥1500 ng/ml) in both groups, while in patients who had recently recovered from COVID-19, they were associated with the absence of a decrease in D-dimer by >50% in the 1st month of standard antithrombotic therapy, the “slow reflow” phenomenon, and “mild” hypercoagulation in combination with low-grade systemic inflammation (CRP 5-9 mg/l). Early SR were associated with mid-grade systemic inflammation (CRP ≥10 mg/l) or a two-fold “jump” in CRP concentration in the first two weeks after PCI while late SRs were associated with long-term (more than 6 months) low-grade systemic inflammation with a median hs-CRP level of 6.6 mg/l. In patients with comorbid obesity and carbohydrate metabolism disorders in the presence of low-grade systemic inflammation after COVID-19, the 6-month risk of developing complications after PCI increased by 66.4% compared to those who were not infected with SARS-CoV-2 (73.4 and 44.1%, respectively; odds ratio (OR) 1.66; 95% confidence interval (CI) 1.45-1.90; p=0.041). In this category of patients, standard pharmacotherapy was not effective enough to prevent the development of such severe cardiovascular complications as myocardial infarction, stroke, and the need for repeated revascularization, the risk of which was 2.1, 2.3 and 2.0 times, respectively, higher in the main group than in the control group.

Conclusion            COVID-19 can worsen the results of PCI in patients with NSTE-ACS. The identified prognostic predictors of ST and SR allow identification of a category of individuals at high risk of complications after PCI and warrant revising the therapeutic strategy for their prevention.

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