Features of antiviral drug treatment in patients with COVID-19 and viral pneumonia with acute myocardial infarction

Relevance. Data on the patterns, frequency, and prognostic impact of antiviral therapy (AVT) in patients with COVID-19 complicated by acute coronary syndrome (ACS) and acute myocardial infarction (AMI) remain limited in real-world clinical settings.

Objective. To evaluate the efficacy and safety of various AVT regimens in patients with COVID-19 pneumonia complicated by AMI and to compare the frequency of monoclonal antibodies (mAbs) and nucleoside analogues (NAs) administration in groups with fatal and favorable outcomes.

Materials and methods. A retrospective cohort study included 83 patients with confirmed COVID-19 and AMI (main group) and 131 patients with COVID-19 and renal dysfunction without ACS (comparison group). Patients were stratified into 4 subgroups based on outcome (death/discharge) and the presence of ACS. The frequency of 12 antiviral drugs (mAbs and NAs) administered within the first 4 days of hospitalization was analyzed. Odds ratios (OR) with 95 % confi dence intervals (CI) were calculated.

Results. Patients with AMI received AVT on average 22 % less frequently than patients without ACS (p < 0.02). Favipiravir use was associated with a reduced risk of death in AMI: prescription frequency in discharged (100 %) vs. deceased (33.3 %) group, OR 3.0 (95 % CI 2.11–4.41; p < 0.001). Tocilizumab improved prognosis in patients with renal dysfunction without ACS (OR 7.02; 95 % CI 4.94–10.3; p < 0.02). Remdesivir use in patients with renal dysfunction was associated with a 31.9 % increase in mortality (OR 1.85; 95 % CI 1.30–2.71; p <0.03).

Conclusion. Favipiravir may exert a cardioprotective effect in AMI associated with COVID-19. Remdesivir should be used with caution in patients with impaired renal function. AVT is underprescribed in patients with ACS compared to the general COVID-19 patient population.

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