Predictors of Worse Outcome in Covid 19 Patients Presenting with Acute Coronary Syndrome

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Background: Acute coronary syndrome (ACS) in COVID-19 patients is thought to arise from atherosclerotic plaque rupture due to endothelial damage, exacerbated by cytokine storms and inflammatory responses. This work aimed to detect the role of different demographic, clinical, functional, angiographic and laboratory data in prediction of ACS occurrence and worsening in patients with Covid 19. Methods: This case-control study involved 120 patients, with over the age of 18 years, both genders, with confirmed COVID-19 diagnosis and suffering from ACS. Three categories of patients were identified: Group A: with COVID 19 and ACS, Group B: without COVID 19 and presenting with ACS and Group C: control group with COVID 19 and no ACS. Results: CK-MB (AUC 0.634, p=0.036, cutoff ≤60 U/L) was a significant predictor of adverse events with 62.07% sensitivity, 50.55% specificity, 28.6% PPV, and 80.7% NPV. EF >50% (AUC 0.690, p<0.001) also predicted adverse events with 75.86% sensitivity, 40.66% specificity, 28.9% PPV, and 84.1% NPV. Univariate and multivariate analyses identified significant predictors of mortality: age, ARDS, D-dimer, CRP (admission/peak), ferritin, AST, CK-MB, EF, Killip class, GRACE score, final TIMI flow, and COVID-19. However, multivariate analysis found GRACE score and COVID-19 as independent mortality predictors. Conclusions: COVID-19 is a reliable indicator of mortality in ACS patients, with the GRACE score being an essential tool for risk assessment.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.