Features of restoring exercise tolerance in patients with acute ST-segment elevation myocardial infarction who underwent COVID-19

Objective: to determine the differences in the nature of the restoration of physical tolerance in the early (hospital) and late (up to 6 months) postinfarction periods in patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent COVID-19. Materials and methods. Included 140 patients with STEMI, stratified into 2 groups: I - the main (52 people) patients with STEMI who suffered COVID-19 1.5-6 months before the development of acute coronary syndrome (ACS), II - the comparison group (88 people) with STEMI without COVID-19 in the anamnesis. PCI was performed with stenting of the infarct-related artery on the first day. A treadmill test was performed on 30-35 days and after 6 months and a test with a 6-minute walk (T6X) on 11-13 days, 30-35 days and 6 months after the moment of STEMI. Results. The distance value at T6X at all control points in the main group was lower than in the control group: by 12.5% on days 11-13, by 20.7% on days 30-35, and by 10.7% after 6 months. The increase in distance at T6X in the postinfarction period in the main group was less than in the control group only by 30-35 days (25.3% vs. 32.5%), and by 6 months it was 41.1% and 39.7%, respectively (p%=0.7087). The value of TFN in the treadmill test for 30-35 days in the main group was 46.2% lower, by the 6th month there were no differences. Conclusion. Patients with STEMI who underwent COVID-19 were characterized by lower TFN at the hospital stage and by the 1st month of treatment, and by the 6th month, the value of TFN in both groups was equivalent according to the results of the treadmill test and 10.7% (p%=0.0015) lower in the main group according to the results of T6X. The data obtained indicate a slowdown in the recovery of TFN in patients with STEMI with COVID-19 in the anamnesis.

1. Belov V.N., Burlachuk V.T., Kozhevnikova S.A., Budnevsky A.V. The effectiveness of the second stage of rehabilitation of patients with myocardial infarction. Medical scientific bulletin of Central Chernozemye. 2020;(82): 3-5 (in Russ.). EDN: CXWOAI.

2. Bubnova M.G., Aronov D.M. Cardiac rehabilitation: stages, principles and international classification of functioning (ICF).Russian Journal of Preventive Medicine. 2020;23(5):40-49 (in Russ.). DOI: 10.17116/profmed20202305140. EDN: UNQBDG

3. Averkov O.V., Duplyakov D.V., Gilyarov M.YU., Novikova N.A., Shakhnovich R.M., Yakovlev A.N., Abugov S.A., Alekyan B.G., et al. 2020 Clinical practice guidelines for Acute ST-segment elevation myocardial infarction.Russian Journal of Cardiology. 2020;25(11):251-310 (in Russ.). DOI: 10.15829/29/1560-4071-2020-4103. EDN: KNQWWK.

4. Mikhin V.P., Korobova V.N., Kharchenko A.V., Chernjatina M.A., Gromnackiу N.I., Spasskiy A.A., Kayushnikov A.B., Ledovskiy S.M., et al. Features of the functional state of patients with acute coronary pathologyand the influence on them of the level of physical rehabilitation at the discharge moment. Challenges in modern medicine. 2018;41(3):400-409 (in Russ.). DOI: 10.18413/2075-4728-2018-41-3-400-409. EDN: YNQYYH.

5. Kenzhaev S.R. Myocardial viability and diastolic function of the left ventricle in acute myocardial infarction. Eurasian Journal of Cardiology. 2019;(S2):208 (in Russ.). EDN: ZPAOIN.

6. Guseva V.P., Malyutina S.K., Ryabikov A.N., Voronina E.V., Shubkina E.V., Sineva A.I. Left ventricular myocardial deformity: age and gender characteristics and associations with cardiovascular diseases. Ateroscleroz. 2017;13(2):41-49 (in Russ.). EDN: YTZWTZ.

7. Raman B., Cassar M.P., Tunnicliffe E.M., Filippini N., Griffanti L., Alfaro-Almagro F., Okell T., Sheerin F., et al. Medium-term effects of SARS-CoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge. EClinicalMedicine. 2021;31:100683. DOI: 10.1016/j.eclinm.2020.100683.

8. Muradyan N.A., Kuzmina I.M., Gvindzhiliya T.R., Balanyan V.M., Popugaev K.A. Features of the myocardial infarction course in convalescents of the new coronavirus infection COVID-19. The Russian Journal of Transplantation. 2023;15(3):390-396 (in Russ.). DOI: 10.23873/2074-0506-2023-15-3-390-396. EDN: URUXYL.

9. Chashchin M.G., Strelkova A.V., Gorshkov A.Yu., Drapkina O.M. Hospital outcomes of myocardial infarction with ST segment elevation in patients who underwent COVID-19.Russian Journal of Cardiology. 2023;28(2):94-101 (in Russ.). DOI: 10.15829/1560-4071-2023-5278. EDN: FPNZUJ.

10. Gu S.X., Tyagi T., Jain K., Gu V.W., Lee S.H., Hwa J.M., Kwan J.M., Krause D.S., et al. Thrombocytopathy and endotheliopathy: crucial contributors to COVID-19 thromboinflammation. Nat Rev Cardiol. 2021;18(3):194-209. DOI: 10.1038/s41569-020-00469-1.

11. Orlova N.V., Omaichikov V.V., Chuvarayan G.A., Spiryakina Ya.G., Arakelov S.E., Titova I.Yu., Petrenko A.P. Study of clinical and diagnostic parameters in patients with acute coronary syndrome who underwent COVID-19. Medical alphabet. 2021;(23):53-57 (in Russ.). DOI: 10.33667/2078-5631-2021-23-53-57. EDN: QPNJLZ

12. Roitman E.V. The recovery of endothelial function in novel coronavirus infection COVID-19 (review). Medical Council. 2021;(14):78-86 (in Russ.). DOI: 10.21518/2079-701X-2021-14-78-86. EDN: VACMHR.

13. Sukovatykh B.S., Nazarenko P.M., Sukovatykh M.B., Bolomatov N.V., Sereditsky A.V., Sidorov D.V., Sereditsky I.A., Feyziev E.E. The effect of coronavirus infection on coronary blood flow in endovascular treatment of patients with acute myocardial infarction. Bulletin of Pirogov National medical & surgical center. 2022; 17(4-2):30-33 (in Russ.). DOI: 10.25881/20728255_2022_17_4_2_30. EDN: WPESOP.

14. Hamadeh A., Aldujeli A., Briedis K., Tecson K., Sanz-Sánchez J., Al Dujeili M., Al-Obeidi A., Luís Diez J.,et al. Characteristics and Outcomes in Patients Presenting with COVID-19 and ST-Segment Elevation Myocardial Infarction. Am J Cardiol. 2020;131:1-6. DOI: 10.1016/j.amjcard.2020.06.063.

15. Akhmentaeva D.A., Kapsultanova D.A., Lisovenko O.I., Rakhmankul D.J., Dursunov S.D., Sovetkanova P.E., Mayufi A.M., Aliakbarov E.A. Influence of COVID 19 coronavirus infection on the severity of coronary heart disease course and the risk of acute myocardial infarction. Bulletin of KazNMU. 2022;(1):121-127 (in Russ.). DOI: 10.53065/kaznmu.2022.47.81.019. EDN: CGEOWI.

16. Rus M., Ardelean A.I., Andronie-Cioara F.L., Filimon G.C. Acute Myocardial Infarction during the COVID-19 Pandemic: Long-Term Outcomes and Prognosis-A Systematic Review. Life (Basel). 2024;14(2):202. DOI: 10.3390/life14020202.

17. Arutyunov G.P., Paleev F.N., Moiseeva O.M., Dragunov D.O., Sokolova A.V., Arutyunov A.G., Zhirov I.V., Blagova O.V., et al. Myocarditis in adults. Clinical guidelines 2020.Russian Journal of Cardiology. 2021;26(11):136-162. (in Russ.). DOI: 10.15829/1560-4071-2021-4790. EDN: SWZXVO

18. Rajan S., Khunti K., Alwan N., Steves C., MacDermott N., Morsella A., Angulo E., Winkelmann J., et al. In the wake of the pandemic: Preparing for Long COVID [Internet]. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2021. URL: https://www.ncbi.nlm.nih.gov/books/NBK569598/

19. Averkov O.V., Duplyakov D.V., Gilyarov M.Yu., Novikova N.A., Shakhnovich R.M., Yakovlev A.N., Abugov S.A., Alekyan B.G., et al. 2020 Clinical practice guidelines for Acute ST-segment elevation myocardial infarction.Russian Journal of Cardiology. 2020;25(11):251-310 (in Russ.). DOI: 10.15829/29/1560-4071-2020-4103. EDN: KNQWWK.

20. Bubnova M.G., Persiyanova-Dubrova A.L. Six-minute walk test in cardiac rehabilitation. Cardiovascular therapy and prevention. 2020;19(4):102-111. (in Russ.). DOI: 10.15829/1728-8800-2020-2561. EDN: TXSJNX.

21. Yap J., Lim F.Y., Gao F., Teo L.L., Lam C.S., Yeo K.K. Correlation of the New York Heart Association Classification and the 6-Minute Walk Distance: A Systematic Review. Clin Cardiol. 2015;38(10):621-628. DOI: 10.1002/clc.22468.

22. Axelrod A.S., Chomakhidze P.S., Syrkin A.L. Stress ECG tests: 10 steps to practice. Moscow: MEDpress-inform, 2020. 208 p. (in Russ.)

23. Ladozhskaya-Gapeenko E.E., Khrapov K.N., Polushin Y.S., Shlyk I.V., Petrishchev N.N., Vartanova I.V. Microcirculation Disorders in Patients with Severe COVID-19. Bulletin of Anesthesiology and Intensive Care. 2021;18(4):7-19 (in Russ.). DOI: 10.21292/2078-5658-2021-18-4-7-19. EDN: WIBIIQ.

24. Lasica R., Djukanovic L., Mrdovic I., Savic L., Ristic A., Zdravkovic M., Simic D., Krljanac G., et al. Acute Coronary Syndrome in the COVID-19 Era-Differences and Dilemmas Compared to the Pre-COVID-19 Era. J Clin Med. 2022;11(11):3024. DOI: 10.3390/jcm11113024.