ST-Segment Elevation in Patients with Covid-19 — A Case Series

This multicenter case series describes 18 patients with confirmed Covid-19 who presented with ST-segment elevation on ECG across six hospitals in New York City during the initial pandemic wave. Half were diagnosed with myocardial infarction (confirmed by angiography), while the rest were considered to have noncoronary myocardial injury. Patients exhibited varied symptoms, with chest pain in one-third, and most were critically ill, requiring intubation. Echocardiography and troponin levels distinguished coronary from noncoronary injury. Diffuse ST elevations were more common in noncoronary injury, while focal lateral ST elevations predominated in infarction cases. In-hospital mortality was 72%, especially high among those with noncoronary myocardial injury. Elevated D-dimer levels were universal, supporting hypotheses of coagulopathy or endothelial injury as drivers of cardiac events in Covid-19.

This multicenter case series describes 18 patients with confirmed Covid-19 who presented with ST-segment elevation on ECG across six hospitals in New York City during the initial pandemic wave. Half were diagnosed with myocardial infarction (confirmed by angiography), while the rest were considered to have noncoronary myocardial injury. Patients exhibited varied symptoms, with chest pain in one-third, and most were critically ill, requiring intubation. Echocardiography and troponin levels distinguished coronary from noncoronary injury. Diffuse ST elevations were more common in noncoronary injury, while focal lateral ST elevations predominated in infarction cases. In-hospital mortality was 72%, especially high among those with noncoronary myocardial injury. Elevated D-dimer levels were universal, supporting hypotheses of coagulopathy or endothelial injury as drivers of cardiac events in Covid-19.