The role of acute respiratory distress syndrome in the adverse outcomes of acute myocardial infarction in patients with SARS-CoV-2 pneumonia on the background of comorbid pathology

Introduction. The high rate of sudden cardiac death in patients with severe SARS-CoV-2 pneumonia is an urgent problem. Aim. To evaluate the role of acute respiratory distress syndrome in the adverse outcomes of acute myocardial infarction in patients with SARS-CoV-2 pneumonia on the background of comorbid pathology.

Materials and methods. The case-control cohort study included patients (n = 83, mean age 72 ± 19 years) with acute myocardial infarction on the background of SARS-CoV-2-pneumonia and comorbid pathology. Group I (n = 56) – with acute respiratory distress syndrome and without percutaneous coronary intervention (deceased), group II (n = 17) – without acute respiratory distress syndrome and percutaneous coronary intervention (survivors), group III (n = 10) – with acute respiratory distress syndrome and percutaneous coronary intervention (deceased). All patients underwent a comprehensive laboratory examination, electrocardiography, transthoracic echocardiography, computed tomography of the chest, measurement of saturation and oxygenation index. Emergency coronary angiography was performed in 28 patients, followed by thrombectomy and stent insertion into an infarct-related artery. There were a total of 67 deceased patients (11 of them patients with percutaneous coronary intervention). The deceased patients underwent a pathological and morphological examination of the heart.

Results. All deceased patients (n = 66) had acute respiratory distress syndrome and accounted for 79,5% of the total number. The majority had acute non-ST segment elevation myocardial infarction and multivessel lesion, while the surviving patients had acute ST elevation myocardial infarction and single-vessel lesion. The surviving patients who underwent successful percutaneous coronary intervention (thrombextraction followed by stent insertion into an infarct–related artery) had lower markers of inflammation and hypercoagulation. The PaO2/Fi02 level is below 234 mmHg. It proved to be a reliable predictor of an unfavorable outcome. Conclusions. Moderate to severe acute respiratory distress syndrome plays an important role in the adverse outcomes of acute myocardial infarction in patients with SARS-CoV-2 pneumonia on the background of comorbid pathology.

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