cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2022-3270cardiovascular-3270Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEW ARTICLESОсобенности патогенеза и течения инфаркта миокарда на фоне COVID-19: описательный обзорFeatures of the pathogenesis and course of myocardial infarction in COVID-19 patients: a descriptive reviewhttps://orcid.org/0000-0001-6292-3837ЧащинМ. Г.ChashchinM. G.

Чащин Михаил Георгиевич — врач-анестезиолог-реаниматолог, научный сотрудник лаборатории микроциркуляции и регионарного кровообращения.

Москва.

Тел.: +7 (977) 433-11-18

Moscow.

dr.chaschin@gmail.comhttps://orcid.org/0000-0002-1423-214XГоршковА. Ю.GorshkovA. Yu.

Горшков Александр Юрьевич — кандидат медицинских наук, руководитель лаборатории микроциркуляции и регионарного кровообращения.

Москва.

Moscow.

aygorshkov@gmail.comhttps://orcid.org/0000-0003-4789-1640СтрелковаА. В.StrelkovaA. V.

Стрелкова Анна Владиславовна — клинический ординатор.

Москва.

Moscow.

strelkovaanya@mail.ruhttps://orcid.org/0000-0002-4453-8430ДрапкинаО. М.DrapkinaO. M.

Драпкина Оксана Михайловна — доктор медицинских наук профессор, академик РАН, директор.

Москва.

Moscow.

drapkina@bk.ruНациональный медицинский исследовательский центр терапии и профилактической медицины Минздрава РоссииNational Medical Research Center for Therapy and Preventive MedicineПервый Московский государственный медицинский университет им. И.М. Сеченова Минздрава России (Сеченовский университет)I.M. Sechenov First Moscow State Medical University20220607202221732703270Copyright © Чащин М.Г., Горшков А.Ю., Стрелкова А.В., Драпкина О.М., 20222022Чащин М.Г., Горшков А.Ю., Стрелкова А.В., Драпкина О.М.Chashchin M.G., Gorshkov A.Y., Strelkova A.V., Drapkina O.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/3270

Пандемия новой коронавирусной инфекции (COVID-19, COronaVIrus Disease-2019) остается одной из наиболее актуальных проблем для специалистов системы здравоохранения в связи с многообразием внелегочных проявлений. Наряду с респираторным синдромом у значительной части больных течение инфекции сопровождается развитием выраженного системного воспалительного ответа и изменениями в системе гемостаза. Это сопряжено с высоким риском развития осложнений, особенно у лиц с сопутствующей сердечно-сосудистой патологией. Цель исследования — анализ и систематизация литературных данных об особенностях патогенеза, клинического течения и исходов инфаркта миокарда (ИМ) у пациентов с COVID-19. При подготовке обзора использовались публикации, индексируемые в базах PubMed, Google Scholar, Web of Science и Cyberleninka. Глубина поиска составила 2 года, начиная с 2020г. В основу обзора вошли обобщенные данные из наиболее актуальных клинических исследований, отчетов и систематических обзоров. Проведенный анализ литературы позволил сделать заключение о том, что публикуемые данные об особенностях ИМ у пациентов с COVID-19 в настоящее время носят противоречивый характер. Политромбозы, сепсис, активация тканевых макрофагов, нарастающая гипоксемия, дисбаланс между потребностью миокарда в кислороде и его доставкой у пациентов с тяжелым течением COVID-19 привели к высокой частоте развития ишемии миокарда 1 и 2 типов. Особо следует отметить, что в ряде случаев ИМ при COVID-19 возникает у больных с интактными коронарными артериями, а его течение сопряжено с высокой частотой развития осложнений, что, в свою очередь, ведет к существенному увеличению летальности в ближайшем и среднесрочном периодах.

The coronavirus disease 2019 (COVID-19) pandemic remains one of the most urgent problems for healthcare professionals due to the variety of non-pulmonary manifestations. Along with the respiratory syndrome in a significant proportion of patients, the disease course is accompanied by pronounced systemic inflammatory response and hemostasis changes. This is associated with a high risk of complications, especially in patients with concomitant cardiovascular pathology. The aim of the study was to analyze and systematize the literature data on the pathogenesis, clinical course, and outcomes of myocardial infarction (MI) in patients with COVID-19. For review, publications indexed in the PubMed, Google Scholar, Web of Science, and Cyberleninka databases were used. The search depth was 2 years, starting from 2020. The review is based on summarized data from the most relevant clinical studies, reports and systematic reviews. The literature analysis made it possible to conclude that the published data on MI in patients with COVID-19 are currently contradictory. Multiple thrombosis, sepsis, macrophage activation, increasing hypoxemia, imbalance between myocardial oxygen supply and demand in patients with severe COVID-19 have led to a high incidence of type 1 and type 2 MI. It should be especially noted that in a number of cases, MI with COVID-19 occurs in patients with intact coronary arteries, and its course is associated with a high incidence of complications, which, in turn, leads to a significant increase in short- and mid-term mortality.

COVID-19инфаркт миокардаCOVID-19myocardial infarctionReferencesSolomon MD, McNulty EJ, Rana JS, et al. The Covid-19 Pandemic and the Incidence of Acute Myocardial Infarction. N Engl J Med. 2020;383:691-3. doi:10.1056/NEJMC2015630.Solomon MD, McNulty EJ, Rana JS, et al. The Covid-19 Pandemic and the Incidence of Acute Myocardial Infarction. N Engl J Med. 2020;383:691-3. doi:10.1056/NEJMC2015630.De Filippo O, D’Ascenzo F, Angelini F, et al. Reduced Rate of Hospital Admissions for ACS during COVID-19 Outbreak in Northern Italy. N Engl J Med. 2020;383:88-9. doi:10.1056/NEJMC2009166.De Filippo O, D’Ascenzo F, Angelini F, et al. Reduced Rate of Hospital Admissions for ACS during COVID-19 Outbreak in Northern Italy. N Engl J Med. 2020;383:88-9. doi:10.1056/NEJMC2009166.Wu J, Mamas M, Rashid M, et al. Patient response, treatments, and mortality for acute myocardial infarction during the COVID-19 pandemic. Eur Hear J — Qual Care Clin Outcomes. 2020;0:1-9. doi:10.1093/ehjqcco/qcaa062.Wu J, Mamas M, Rashid M, et al. Patient response, treatments, and mortality for acute myocardial infarction during the COVID-19 pandemic. Eur Hear J — Qual Care Clin Outcomes. 2020;0:1-9. doi:10.1093/ehjqcco/qcaa062.Papafaklis MI, Katsouras CS, Tsigkas G, et al. “Missing” acute coronary syndrome hospitalizations during the COVID-19 era in Greece: Medical care avoidance combined with a true reduction in incidence? Clin Cardiol. 2020;43:1142-9. doi:10.1002/CLC.23424.Papafaklis MI, Katsouras CS, Tsigkas G, et al. “Missing” acute coronary syndrome hospitalizations during the COVID-19 era in Greece: Medical care avoidance combined with a true reduction in incidence? Clin Cardiol. 2020;43:1142-9. doi:10.1002/CLC.23424.Bhatt AS, Moscone A, McElrath EE, et al. Fewer Hospitalizations for Acute Cardiovascular Conditions During the COVID-19 Pandemic. J Am Coll Cardiol. 2020;76:280-8. doi:10.1016/J.JACC.2020.05.038.Bhatt AS, Moscone A, McElrath EE, et al. Fewer Hospitalizations for Acute Cardiovascular Conditions During the COVID-19 Pandemic. J Am Coll Cardiol. 2020;76:280-8. doi:10.1016/J.JACC.2020.05.038.D’Ascenzo F, De Filippo O, Borin A, et al. Impact of COVID-19 pandemic and infection on in hospital survival for patients presenting with acute coronary syndromes: A multicenter registry. Int J Cardiol. 2021;332:227-34. doi:10.1016/J.IJCARD.2021.03.063.D’Ascenzo F, De Filippo O, Borin A, et al. Impact of COVID-19 pandemic and infection on in hospital survival for patients presenting with acute coronary syndromes: A multicenter registry. Int J Cardiol. 2021;332:227-34. doi:10.1016/J.IJCARD.2021.03.063.Matsushita K, Hess S, Marchandot B, et al. Clinical features of patients with acute coronary syndrome during the COVID-19 pandemic. J Thromb Thrombolysis. 2020:1-10. doi:10.1007/s11239-020-02340-z.Matsushita K, Hess S, Marchandot B, et al. Clinical features of patients with acute coronary syndrome during the COVID-19 pandemic. J Thromb Thrombolysis. 2020:1-10. doi:10.1007/s11239-020-02340-z.Morishita T, Takada D, Shin J, et al. Trends, Treatment Approaches, and In-Hospital Mortality for Acute Coronary Syndrome in Japan During the Coronavirus Disease 2019 Pandemic. J Atheroscler Thromb. 2021; 29(5):597-607 doi:10.5551/JAT.62746.Morishita T, Takada D, Shin J, et al. Trends, Treatment Approaches, and In-Hospital Mortality for Acute Coronary Syndrome in Japan During the Coronavirus Disease 2019 Pandemic. J Atheroscler Thromb. 2021; 29(5):597-607 doi:10.5551/JAT.62746.Braiteh N, Rehman W ur, Alom M, et al. Decrease in acute coronary syndrome presentations during the COVID-19 pandemic in upstate New York. Am Heart J. 2020;226:147-51. doi:10.1016/j.ahj.2020.05.009.Braiteh N, Rehman W ur, Alom M, et al. Decrease in acute coronary syndrome presentations during the COVID-19 pandemic in upstate New York. Am Heart J. 2020;226:147-51. doi:10.1016/j.ahj.2020.05.009.Solano-López J, Zamorano JL, Pardo Sanz A, et al. Risk factors for in-hospital mortality in patients with acute myocardial infarction during the COVID-19 outbreak. Rev Esp Cardiol. 2020;73:985-93. doi:10.1016/j.rec.2020.07.009.Solano-López J, Zamorano JL, Pardo Sanz A, et al. Risk factors for in-hospital mortality in patients with acute myocardial infarction during the COVID-19 outbreak. Rev Esp Cardiol. 2020;73:985-93. doi:10.1016/j.rec.2020.07.009.Дружинин П. В., Молчанова Е. В. Смертность населения российских регионов в условиях пандемии COVID-19. Регионология. 2021;29:666-85. doi:10.15507/2413-1407.116.029.202103.666-685.Druzhinin PV, Molchanova EV. Mortality Rates in Russian Regions in the Context of the COVID-19 Pandemic. Regionology. 2021;29:666-85. (In Russ.) doi:10.15507/2413-1407.116.029.202103.666-685.Campo G, Fortuna D, Berti E, et al. In- and out-of-hospital mortality for myocardial infarction during the first wave of the COVID-19 pandemic in Emilia-Romagna, Italy: A population-based observational study. Lancet Reg Heal — Eur. 2021;3:100055. doi:10.1016/J.LANEPE.2021.100055.Campo G, Fortuna D, Berti E, et al. In- and out-of-hospital mortality for myocardial infarction during the first wave of the COVID-19 pandemic in Emilia-Romagna, Italy: A population-based observational study. Lancet Reg Heal — Eur. 2021;3:100055. doi:10.1016/J.LANEPE.2021.100055.Marijon E, Karam N, Jost D, et al. Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study. Lancet Public Heal. 2020;5:e437-43. doi:10.1016/S2468-2667(20)30117-1.Marijon E, Karam N, Jost D, et al. Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study. Lancet Public Heal. 2020;5:e437-43. doi:10.1016/S2468-2667(20)30117-1.Lim ZJ, Ponnapa Reddy M, Afroz A, et al. Incidence and outcome of out-of-hospital cardiac arrests in the COVID-19 era: A systematic review and meta-analysis. Resuscitation. 2020;157:248-58. doi:10.1016/j.resuscitation.2020.10.025.Lim ZJ, Ponnapa Reddy M, Afroz A, et al. Incidence and outcome of out-of-hospital cardiac arrests in the COVID-19 era: A systematic review and meta-analysis. Resuscitation. 2020;157:248-58. doi:10.1016/j.resuscitation.2020.10.025.Hanff TC, Mohareb AM, Giri J, et al. Thrombosis in COVID-19. Am J Hematol. 2020;95:1578-89. doi:10.1002/AJH.25982.Hanff TC, Mohareb AM, Giri J, et al. Thrombosis in COVID-19. Am J Hematol. 2020;95:1578-89. doi:10.1002/AJH.25982.Tajbakhsh A, Gheibi Hayat SM, Taghizadeh H, et al. COVID-19 and cardiac injury: clinical manifestations, biomarkers, mechanisms, diagnosis, treatment, and follow up. Expert Review of Antiinfective Therapy. 2020;19:345-57. doi:10.1080/14787210.2020.1 822737.Tajbakhsh A, Gheibi Hayat SM, Taghizadeh H, et al. COVID-19 and cardiac injury: clinical manifestations, biomarkers, mechanisms, diagnosis, treatment, and follow up. Expert Review of Antiinfective Therapy. 2020;19:345-57. doi:10.1080/14787210.2020.1822737.Choudry FA, Hamshere SM, Rathod KS, et al. High Thrombus Burden in Patients With COVID-19 Presenting With ST-Segment Elevation Myocardial Infarction. J Am Coll Cardiol. 2020;76:1168-76. doi:10.1016/j.jacc.2020.07.022.Choudry FA, Hamshere SM, Rathod KS, et al. High Thrombus Burden in Patients With COVID-19 Presenting With ST-Segment Elevation Myocardial Infarction. J Am Coll Cardiol. 2020;76:1168-76. doi:10.1016/j.jacc.2020.07.022.Dominguez-Erquicia P, Dobarro D, Raposeiras-Roubín S, et al. Multivessel coronary thrombosis in a patient with COVID-19 pneumonia. Eur Heart J. 2020;41:2132. doi:10.1093/EURHEARTJ/EHAA393.Dominguez-Erquicia P, Dobarro D, Raposeiras-Roubín S, et al. Multivessel coronary thrombosis in a patient with COVID-19 pneumonia. Eur Heart J. 2020;41:2132. doi:10.1093/EURHEARTJ/EHAA393.Tedeschi D, Rizzi A, Biscaglia S, et al. Acute myocardial infarction and large coronary thrombosis in a patient with COVID-19. Catheter Cardiovasc Interv. 2020:ccd.29179. doi:10.1002/ccd.29179.Tedeschi D, Rizzi A, Biscaglia S, et al. Acute myocardial infarction and large coronary thrombosis in a patient with COVID-19. Catheter Cardiovasc Interv. 2020:ccd.29179. doi:10.1002/ccd.29179.Tersalvi G, Vicenzi M, Calabretta D, et al. Elevated Troponin in Patients With Coronavirus Disease 2019: Possible Mechanisms. J Card Fail. 2020;26:470-5. doi:10.1016/J.CARDFAIL.2020.04.009.Tersalvi G, Vicenzi M, Calabretta D, et al. Elevated Troponin in Patients With Coronavirus Disease 2019: Possible Mechanisms. J Card Fail. 2020;26:470-5. doi:10.1016/J.CARDFAIL.2020.04.009.Long B, Brady WJ, Koyfman A, et al. Cardiovascular complications in COVID-19. Am J Emerg Med. 2020;38:1504-7. doi:10.1016/J.AJEM.2020.04.048.Long B, Brady WJ, Koyfman A, et al. Cardiovascular complications in COVID-19. Am J Emerg Med. 2020;38:1504-7. doi:10.1016/J.AJEM.2020.04.048.Khan IH, Zahra SA, Zaim S, et al. At the heart of COVID-19. J Card Surg. 2020;35:1287-94. doi:10.1111/JOCS.14596.Khan IH, Zahra SA, Zaim S, et al. At the heart of COVID-19. J Card Surg. 2020;35:1287-94. doi:10.1111/JOCS.14596.Sandoval Y, Januzzi JL, Jaffe AS. Cardiac Troponin for Assessment of Myocardial Injury in COVID-19: JACC Review Topic of the Week. J Am Coll Cardiol. 2020;76:1244-58. doi:10.1016/J.JACC.2020.06.068.Sandoval Y, Januzzi JL, Jaffe AS. Cardiac Troponin for Assessment of Myocardial Injury in COVID-19: JACC Review Topic of the Week. J Am Coll Cardiol. 2020;76:1244-58. doi:10.1016/J.JACC.2020.06.068.Loghin C, Chauhan S, Lawless SM. Pseudo-Acute Myocardial Infarction in a Young COVID-19 Patient. JACC Case Reports. 2020;2:1284-8. doi:10.1016/J.JACCAS.2020.04.015.Loghin C, Chauhan S, Lawless SM. Pseudo-Acute Myocardial Infarction in a Young COVID-19 Patient. JACC Case Reports. 2020;2:1284-8. doi:10.1016/J.JACCAS.2020.04.015.Барбараш О. Л., Дупляков Д. В., Затейщиков Д. А. и др. Острый коронарный синдром без подъема сегмента ST электрокардиограммы. Клинические рекомендации 2020. Российский кардиологический журнал. 2021;26(4):4449. doi:10.15829/1560-4071-2021-4449.Barbarash OL, Duplyakov DV, Zateischikov DA, et al. 2020 Clinical practice guidelines for Acute coronary syndrome without ST segment elevation. Russian Journal of Cardiology. 2021;26(4):4449. (In Russ.) doi:10.15829/1560-4071-2021-4449.Mahajan K, Chandra KS. Cardiovascular comorbidities and complications associated with coronavirus disease 2019. Med J Armed Forces India. 2020;76:253-60. doi:10.1016/J.MJAFI.2020.05.004.Mahajan K, Chandra KS. Cardiovascular comorbidities and complications associated with coronavirus disease 2019. Med J Armed Forces India. 2020;76:253-60. doi:10.1016/J.MJAFI.2020.05.004.Halushka MK, Vander Heide RS. Myocarditis is rare in COVID-19 autopsies: cardiovascular findings across 277 postmortem examinations. Cardiovasc Pathol. 2021;50:107300. doi:10.1016/J.CARPATH.2020.107300.Halushka MK, Vander Heide RS. Myocarditis is rare in COVID-19 autopsies: cardiovascular findings across 277 postmortem examinations. Cardiovasc Pathol. 2021;50:107300. doi:10.1016/J.CARPATH.2020.107300.Khalid N, Chen Y, Case BC, et al. COVID-19 (SARS-CoV-2) and the Heart — An Ominous Association. Cardiovasc Revascularization Med. 2020;21:946-9. doi:10.1016/J.CARREV.2020.05.009.Khalid N, Chen Y, Case BC, et al. COVID-19 (SARS-CoV-2) and the Heart — An Ominous Association. Cardiovasc Revascularization Med. 2020;21:946-9. doi:10.1016/J.CARREV.2020.05.009.AL Abbasi B, Torres P, Ramos-Tuarez F, et al. Cardiac Troponin-I and COVID-19: A Prognostic Tool for In-Hospital Mortality. Cardiol Res. 2020;11:398-404. doi:10.14740/cr.1159.AL Abbasi B, Torres P, Ramos-Tuarez F, et al. Cardiac Troponin-I and COVID-19: A Prognostic Tool for In-Hospital Mortality. Cardiol Res. 2020;11:398-404. doi:10.14740/cr.1159.Gaze DC. Clinical utility of cardiac troponin measurement in COVID-19 infection. Ann Clin Biochem. 2020;57:202-5. doi:10.1177/0004563220921888.Gaze DC. Clinical utility of cardiac troponin measurement in COVID-19 infection. Ann Clin Biochem. 2020;57:202-5. doi:10.1177/0004563220921888.Chapman AR, Bularga A, Mills NL. High-Sensitivity Cardiac Troponin Can Be an Ally in the Fight against COVID-19. Circulation. 2020;141:1733-5. doi:10.1161/CIRCULATIONAHA.120.047008.Chapman AR, Bularga A, Mills NL. High-Sensitivity Cardiac Troponin Can Be an Ally in the Fight against COVID-19. Circulation. 2020;141:1733-5. doi:10.1161/CIRCULATIONAHA.120.047008.Rashid M, Wu J, Timmis A, et al. Outcomes of COVID-19-positive acute coronary syndrome patients: A multisource electronic healthcare records study from England. J Intern Med. 2021;290:88-100. doi:10.1111/JOIM.13246.Rashid M, Wu J, Timmis A, et al. Outcomes of COVID-19-positive acute coronary syndrome patients: A multisource electronic healthcare records study from England. J Intern Med. 2021;290:88-100. doi:10.1111/JOIM.13246.Pepe M, Frati G, Biondi-Zoccai G, et al. Direct and indirect effects of COVID-19 on acute coronary syndromes: Can we pick the worst? Int J Cardiol. 2021;335:19-20. doi:10.1016/J.IJCARD.2021.04.036.Pepe M, Frati G, Biondi-Zoccai G, et al. Direct and indirect effects of COVID-19 on acute coronary syndromes: Can we pick the worst? Int J Cardiol. 2021;335:19-20. doi:10.1016/J.IJCARD.2021.04.036.

The authors declare that there are no conflicts of interest present.