Assessing the Impact of COVID-19 on Angiographic Characteristics in Patients with ST- Elevation Myocardial Infarction: A Matched Cohort Analysis

Abstract Background The COVID-19 pandemic has significantly influenced the presentation and management of cardiovascular disease, raising concerns regarding increased thrombotic events and altered manifestations of ST-elevation myocardial infarction (STEMI). However, a critical knowledge gap remains regarding the specific impact of COVID-19 on coronary angiographic characteristics in STEMI patients, posing challenges for optimizing treatment strategies. This study addresses this gap by systematically evaluating the angiographic features and procedural outcomes of STEMI patients with concurrent SARS-CoV-2 infection. Objectives This study compared coronary angiographic findings, procedural outcomes, and in-hospital events between STEMI patients with and without COVID-19 matched cohort design. We hypothesized that STEMI patients with SARS-CoV-2 infection have a thrombus burden, increased lesion complexity, and a greater prevalence of multi-vessel disease. Methods A retrospective matched cohort study was conducted at a tertiary medical center. A total of 85 STEMI patients with confirmed COVID-19 were matched in a 1:1 ratio with 85 COVID-19-negative STEMI patients based on age and baseline clinical characteristics. Blinded cardiologists performed coronary angiographic assessments, evaluating key parameters such as thrombus burden, lesion complexity, and the presence of multi-vessel disease. Procedural success was determined using TIMI flow grade, while in-hospital outcomes, including major adverse cardiac events (MACE) and mortality, were analyzed. Statistical comparisons employed t-tests, Chi-square tests, and multivariable logistic regression to account for potential confounders. Results ST-segment elevation MI patients with COVID-19 exhibited a significantly higher thrombus burden (3.4 ± 0.7 vs. 2.3 ± 0.8, p<0.001), increased lesion complexity (mean lesion length: 23.6 ± 5.2 mm vs. 19.8 ± 4.7 mm, p=0.002), and a greater prevalence of multi-vessel disease (38% vs. 20%, p=0.01). The success rates of interventions were lower among COVID-19-positive patients (81% vs. 92%, p=0.04). Multivariable logistic regression analysis identified COVID-19 as an independent predictor of high thrombus burden (OR 2.5; 95% CI: 1. 3) and multi-Vessel disease (OR 1.9; 95% CI: 1.2). Conclusions COVID-19 significantly influences coronary angiographic characteristics in STEMI patients, leading to a higher thrombus burden, increased lesion complexity, and a greater prevalence of multi-Vessel disease. These findings underscore the need for tailored interventional strategies and intensified antithrombotic therapy in this high-risk population to improve procedural success and in-hospital outcomes.