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    Poster Networking

    Immunothrombosis

    Poster Networking Session

    PB0774 - The role of immunothrombosis in acute coronary syndrome (ACS) patients during COVID-19 pandemic: Analysis during a 2 year follow-up

    Monday, June 26, 2023
    18:30 – 19:30 ET
    Room: Exhibition

      Co-Author(s)

    • Patricia Gomez Rosas, MD

      Hematologist
      Hospital Pappa Giovanni XXIII
      Bergamo, Lombardia, Italy

      • Presenting Author(s)

    • Marina Marchetti, PhD (she/her/hers)

      Hemostasis Lab Director
      Department of Immunohematology and Transfusion Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

      • Co-Author(s)

    • IP

      Irene Pescetelli

      Cardiologist
      Cardiovascular Department, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

    • ES

      Eleonora Sanga

      Researcher
      Department of Immunohematology and Transfusion Medicine, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

    • LR

      Laura Russo

      Researcher
      Department of Immunohematology and Transfusion Medicine, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

    • SG

      Sara Gamba

      Researcher
      Department of Immunohematology and Transfusion Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

    • CV

      Cristina Verzeroli

      Researcher
      Department of Immunohematology and Transfusion Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

    • DP

      Dario Pellegrini

      Cardiologist
      Cardiovascular Department, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

    • LF

      Luigi Fiocca

      Cardiologist
      Cardiovascular Department, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

    • PC

      Paolo Angelo Canova

      Cardiologist
      Cardiovascular Department, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

    • AV

      Angelina Vassileva

      Cardiologist
      Cardiovascular Department, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

    • FM

      Francesco Moretti

      Cardiologist
      Cardiovascular Department, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

    • AG

      Aurelia Grosu

      Cardiologist
      Cardiovascular Department, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

    • GG

      Giulio Guagliumi

      Cardiologist
      Cardiovascular Department, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

    • Anna Falanga, MD (she/her/hers)

      Professor of Hematology
      Department of Immunohematology and Transfusion Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
      Bergamo, Lombardia, Italy

    Background: Systemic inflammation and coagulation derangement are hallmarks of both ACS and severe SARS-CoV2 infection.

    Aims: To prospectively evaluate the contribution of COVID-19 to the hemostatic system derangement in ACS-patients (EMOCOVIDstudy/ClinicalTrials.gov_ID#04595110). Hemostatic biomarkers as risk predictors for in-hospital and post-discharge major adverse cardiovascular/cerebrovascular events (MACCEs) were also explored.

    Methods: Ninety-nine (75M/24F) consecutive ACS-patients were prospectively enrolled (March-May 2020) and followed-up for 2 years. On admission, blood samples were collected to measure inflammatory biomarkers (neutrophil extracellular traps, CRP, procalcitonin), hypercoagulability (D-dimer, prothrombin fragment 1+2), coagulation (von Willebrand factor, coagulation factors, protein C, free-protein S, and antithrombin), and fibrinolysis (tissue plasminogen activator, and its inhibitor PAI-1). MACCEs occurrence was monitored during hospitalization and after discharge.

    Results: Within the cohort, 24 patients (24%) resulted positive and 75 (76%) negative for SARS-CoV2 infection. Among SARS-CoV2 positive patients, 67% had ST-elevation myocardial infarction (STEMI), 33% non-STEMI (NSTEMI) and 8% unstable angina (UA). Comparable frequencies were observed in SARS-CoV-2 negative group (i.e., 53% STEMI, 37% NSTEMI, 9% UA). Parameters of both hemostatic and inflammatory compartments were significantly (p < 0.05) altered in all ACS-patients towards a hypercoagulable and pro-inflammatory state, with SARS-CoV-2 positive subjects displaying the most altered pattern. During hospitalization, 24 MACCEs occurred, 54% in SARS-CoV2 positive vs 15% in negative group (p=0.032). Cardiovascular death was the most frequent event in SARS-CoV2 positive vs negative group (p=0.008). Analysis of clinical and biological data identified lower FXII and higher D-dimer levels as independent predictive factors of in-hospital MACCEs (p < 0.05), independently of ACS-diagnosis. After discharge, 19 MACCEs were recorded. Among the different clinical/laboratory variables, only SARS-CoV2-positivity at admission was associated with an increased risk of death (p=0.013).

    Conclusion(s): Our data demonstrate the contribution of SARS-CoV2 infection in triggering dysregulation of hemostasis in patients with ACS. The infection in these patients significantly contributes to an increased risk of both in-hospital and post-discharge death.