Pathogenesis of Acute Coronary Syndromes in Patients After COVID-19: An Optical Coherence Tomography Study

Bryniarski, Krzysztof L.; Bartus, Stanislaw; Legutko, Jacek; Bryniarski, Leszek; Gasior, Pawel; Wojakowski, Wojciech; Rzeszutko, Lukasz; Dziewierz, Artur; Zasada, Wojciech; Rakowski, Tomasz; Makowicz, Dawid; Wojdyla, Roman; Kleczynski, Pawel; Jang, Ik-Kyung

doi:10.3390/jcm14248895

Open AccessArticle

Pathogenesis of Acute Coronary Syndromes in Patients After COVID-19: An Optical Coherence Tomography Study

by

Krzysztof L. Bryniarski

^1,2,*,

Stanislaw Bartus

^3,4

,

Jacek Legutko

^1,2

,

Leszek Bryniarski

^3,4,

Pawel Gasior

⁵

,

Wojciech Wojakowski

⁵

,

Lukasz Rzeszutko

^3,4

,

Artur Dziewierz

^3,4

,

Wojciech Zasada

^3,4

,

Tomasz Rakowski

^3,4

,

Dawid Makowicz

^6,7,

Roman Wojdyla

^3,4

,

Pawel Kleczynski

^1,2

and

Ik-Kyung Jang

^8,9

¹

Clinical Department of Interventional Cardiology, Saint John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland

²

Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-530 Kraków, Poland

³

Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital in Krakow, 30-688 Kraków, Poland

⁴

2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Kraków, Poland

⁵

Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland

⁶

Healt Institute, State University of Applied Sciences in Krosno, 38-400 Krosno, Poland

⁷

Center of Invasive Cardiology, Angiology and Electrotherapy, Intercard, 38-400 Krosno, Poland

⁸

Cardiology Division, Massachusetts General Hospital—Harvard Medical School, Boston, MA 02114, USA

⁹

Division of Cardiology, Kyung Hee University Hospital, Seoul 02447, Republic of Korea

^*

Author to whom correspondence should be addressed.

J. Clin. Med. 2025, 14(24), 8895; https://doi.org/10.3390/jcm14248895

Submission received: 6 November 2025 / Revised: 8 December 2025 / Accepted: 10 December 2025 / Published: 16 December 2025

(This article belongs to the Section Cardiology)

Download

Browse Figures

Versions Notes

Abstract

Background: Whilst COVID-19 mainly affects the lungs, multiple other organs were also involved—patients with COVID-19 were reported to be at higher risk of acute coronary syndromes (ACS). Importantly, results show that the risk of ACS may extend well beyond the acute phase of COVID-19 infection. In our study, we sought to investigate optical coherence tomography (OCT)-derived vascular changes, including the prevalence of plaque erosion in patients who had recent COVID-19. Methods: Patients with ACS were divided into two groups: those after COVID-19 infection during the past 12 months (post-COVID group) and those without known prior COVID infection (non-COVID group). We enrolled 35 patients in the post-COVID group and 35 patients in the non-COVID group. Results: The mean time from COVID infection to the imaging in the post-COVID group was 10 ± 1 months. There were no major differences in baseline demographic, clinical, or laboratory characteristics between the two groups. Erosion was the underlying pathology in one-third (34.3%) of the non-COVID group and in one-half (48.6%) of the post-COVID group, although the difference did not reach statistical significance. No calcified nodules were observed. The lipid core tended to be longer in the post-COVID group (9.1 ± 3.6 vs. 12.0 ± 1.9 mm; p = 0.005), and the prevalence of macrophages was higher in patients who had prior COVID-19 infection (48.6 vs. 74.3%; p = 0.027). Conclusions: Our OCT study demonstrated that patients with a prior COVID-19 infection tended to have a higher prevalence of plaque erosion and more vulnerable plaque morphology at the culprit lesion compared to those without a history of prior COVID-19 infection.

Keywords: acute coronary syndromes; percutaneous coronary intervention; coronavirus-2019; optical coherence tomography; coronary plaque morphology

Share and Cite

MDPI and ACS Style

Bryniarski, K.L.; Bartus, S.; Legutko, J.; Bryniarski, L.; Gasior, P.; Wojakowski, W.; Rzeszutko, L.; Dziewierz, A.; Zasada, W.; Rakowski, T.; et al. Pathogenesis of Acute Coronary Syndromes in Patients After COVID-19: An Optical Coherence Tomography Study. J. Clin. Med. 2025, 14, 8895. https://doi.org/10.3390/jcm14248895

AMA Style

Bryniarski KL, Bartus S, Legutko J, Bryniarski L, Gasior P, Wojakowski W, Rzeszutko L, Dziewierz A, Zasada W, Rakowski T, et al. Pathogenesis of Acute Coronary Syndromes in Patients After COVID-19: An Optical Coherence Tomography Study. Journal of Clinical Medicine. 2025; 14(24):8895. https://doi.org/10.3390/jcm14248895

Chicago/Turabian Style

Bryniarski, Krzysztof L., Stanislaw Bartus, Jacek Legutko, Leszek Bryniarski, Pawel Gasior, Wojciech Wojakowski, Lukasz Rzeszutko, Artur Dziewierz, Wojciech Zasada, Tomasz Rakowski, and et al. 2025. "Pathogenesis of Acute Coronary Syndromes in Patients After COVID-19: An Optical Coherence Tomography Study" Journal of Clinical Medicine 14, no. 24: 8895. https://doi.org/10.3390/jcm14248895

APA Style

Bryniarski, K. L., Bartus, S., Legutko, J., Bryniarski, L., Gasior, P., Wojakowski, W., Rzeszutko, L., Dziewierz, A., Zasada, W., Rakowski, T., Makowicz, D., Wojdyla, R., Kleczynski, P., & Jang, I.-K. (2025). Pathogenesis of Acute Coronary Syndromes in Patients After COVID-19: An Optical Coherence Tomography Study. Journal of Clinical Medicine, 14(24), 8895. https://doi.org/10.3390/jcm14248895

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Menu

Pathogenesis of Acute Coronary Syndromes in Patients After COVID-19: An Optical Coherence Tomography Study

Abstract

Share and Cite

Article Metrics

Article Access Statistics

Further Information

Guidelines

MDPI Initiatives

Follow MDPI