ST-segment elevation in COVID-19: nonobstructive disease is common

  • Bangalore S & al.
  • N Engl J Med
  • 17 abr. 2020

  • de Emily Willingham, PhD
  • Clinical Essentials
El acceso al contenido completo es sólo para profesionales sanitarios registrados. El acceso al contenido completo es sólo para profesionales sanitarios registrados.

Takeaway

  • ST-segment elevation with COVID-19 presents in a variable way, with nonobstructive disease highly prevalent, elevated d-dimer, and a poor prognosis.

Why this matters

  • ST-segment elevation with COVID-19 has been reported in a number of countries.
  • These authors note that the cause of myocardial injury in COVID-19 has yet to be established.

Key results

  • Median age, 63 years; 83% men.
  • 10 had it at presentation; 8 developed it during hospitalization.
  • 14 had focal ST-segment elevation.
  • 5 had normal left ventricular ejection fraction (LVEF), 8 had reduced LVEF, 1 did not undergo echo.
  • 4 had diffuse ST-segment elevation, 3 with normal LVEF, 1 with LVEF 10%.
  • 9 patients had coronary angiography; 6 of these had obstructive disease, 5 of whom had percutaneous coronary intervention.
  • 18/18 had elevated d-dimer; the 8 with myocardial infarction had higher d-dimer and median peak troponin.
  • 13/18 died in-hospital.

Study design

  • Case series of 18 patients at 6 hospitals.
  • Funding: None disclosed.

Limitations

  • Case series with small numbers.
  • Patients varied in comorbidities, presentation, lung status, treatment regimen.