Background: On-site thrombolysis as an alternative to transfer for primary PCI (pPCI) was utilized during COVID-19 first peak in many localities enforced by the overwhelming burden on the unprepared health systems. However, higher rates of thrombolysis failure, and excess of STEMIs secondary to stent thrombosis were frequently reported during COVID-19 first peak, questioning a potential linkage to SARS-CoV-2-related prothrombotic status. The recent alarming spread by the new emerging SARS-CoV-2 variants in many regions threatens low- and middle-income countries by overwhelming crises similar to the commencement of the pandemic. In this retrospective analysis, we contrasted the clinical profiles, revascularization strategies and outcomes of STEMI patients presenting to our system during the first COVID-19 surge (n=37), to STEMI presentations in the same interval of the previous year (n=77), to inspect the impact of COVID-19 on STEMI presentations and outcomes.

Results: Patients' profiles were mostly comparable between the COVID-19-era- and the control- groups. Compared to the controls, STEMI patients during the COVID-19-era had significantly higher rates of thrombolysis failure (5 (63%) vs 3 (21%), p = 0.05) and of STEMIs due to stent thrombosis (5 (16%) vs 2 (3%), p = 0.01).

Conclusions: A prevalent prothrombotic milieu parallels SARS-CoV-2 upsurges, disproportionately exceeding numbers of confirmed SARS-CoV-2 infections. This prothrombotic status probably enhanced stent thrombosis and reduced success of thrombolysis in STEMI cohorts. It is prudent to consider these observations in the unluckily event we faced recurrent upsurges dominated by the emerging SARS-CoV-2 variants.