Thrombus Burden in Covid-19 and Non-Covid -19 Patients Presenting with STEMI

Background: The SARS-CoV-2 virus primarily induces respiratory dysfunction; though, cardiovascular complications including myocardial injury, acute heart failure, arrhythmias, and venous thromboembolism take place more commonly than formerly anticipated. The aim was to assess the thrombus burden score in ST-Elevation Myocardial Infarction (STEMI) patients during primary percutaneous coronary intervention (1ry PCI) in the COVID-19 cases versus non-COVID-19 cases. Methods: This single-center, observational study included 120 consecutive cases hospitalized with confirmed STEMI. For all enrolled cases, 1ry PCI was determined as the standard treatment. cases were equally allocated into two groups regarding the presence or absence of COVID-19: Group 1: cases with STEMI associated with confirmed COVID-19 infection and Group 2: cases with STEMI not associated with COVID-19 infection. Results: ROC analysis identified CRP as a good biomarker of high thrombus burden (Grade ≥4) in STEMI cases, with an optimal cut-off of 41.2 mg/L (AUC = 0.78; 95% CI: 0.69-0.87; p < 0.0001). At this threshold, CRP showed 59% sensitivity, 95% specificity, and 65% accuracy, supporting its utility in COVID-19-associated STEMI. D-dimer demonstrated strong predictive performance with a cut-off of 1.1 mg/L (AUC = 0.78; 95% CI: 0.69-0.88; p < 0.0001), yielding 61% sensitivity, 100% specificity and 68% accuracy, highlighting its high specificity for substantial thrombus burden. Troponin T was highly specific but less sensitive at a cut-off of 1118 ng/L (AUC = 0.77; 95% CI: 0.68-0.87; p < 0.0001), with 48% sensitivity, 100% specificity and 57% accuracy, limiting its role as a standalone screening marker. Ferritin showed acceptable discrimination at 299.8 µg/L (AUC = 0.73; 95% CI: 0.63-0.84; p < 0.0001), with 56% sensitivity, 100% specificity and 63% accuracy, supporting its use as a confirmatory rather than screening marker. Conclusion: COVID-19 significantly worsens thrombus burden, inflammatory response, and outcomes in STEMI patients, underscoring the need for tailored management and early risk stratification in these high-risk cases.