The GRACE risk score in patients with ST-segment elevation myocardial infarction and concomitant COVID-19

Abstract

Introduction: Acute coronary syndrome represents a major cause of mortality throughout the world. To date, there are only a few reports of ST-segment elevation type 1 myocardial infarction in patients with COVID-19. The aim of this study was to describe the clinical and angiographic characteristics alongside the prediction of in-hospital mortality using the GRACE risk score in this group. Material and methods: This was a single-center, retrospective study of consecutive patients admitted to a multi-specialist hospital with confirmed ST-segment elevation myocardial infarction (STEMI) and treated with primary percutaneous coronary intervention. Demographic, clinical and angio-graphic characteristics were compared between survivors and non-survivors. Results: Twenty-five patients, of whom 23 (92%) were men, with confirmed STEMI and COVID-19, with a median age of 70 years and high comorbidity burden, were included in this study. They were treated with percutaneous coronary intervention and 12 (48%) of them died. Non-survivors had elevated high-sensitivity C-reactive protein (hsCRP) (p = 0.026) and D-dimer (p = 0.042) and reduced left ventricular ejection fraction (30 ±9 vs. 41 ±7; p = 0.003). Postprocedural TIMI 3 flow grade was less frequently observed in this group (p = 0.039). There was a higher GRACE score in the non-survivor group (mean ± SD; 210 ±35 vs. 169 ±42, p = 0.014). In ROC analysis, GRACE score predicted in-hospital death with an AUC of 0.788 (95% CI: 0.6-0.98, p = 0.014). A score of 176 was identified as the optimal cutoff with a sensitivity of 92% and specificity of 69%. Conclusions: The GRACE risk score is a good predictor of in-hospital mortality in patients presenting with STEMI with concomitant COVID-19.