Acute Coronary Syndrome in the COVID-19 Era—Differences and Dilemmas Compared to the Pre-COVID-19 Era

Lasica, Ratko; Djukanovic, Lazar; Mrdović, Igor; Savić, Lidija; Ristić, Arsen; Zdravković, Marija; Simić, Dragan; Krljanać, Gordana; Popović, Dejana; Simeunović, Dejan; Rajic, Dubravka; Ašanin, Milika

doi:10.3390/jcm11113024

Cited by 15 publications

(5 citation statements)

References 121 publications

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“…With additional data, it could be possible to identify factors that could lead to the increased incidence of AMI, with the ultimate goal of a timely diagnostic and early recognition, as well as the education of the population, especially the elderly, about the signs and symptoms of AMI. [14][15][16] This study showed the influence and significance of circadian rhythms and seasonal variations on the incidence of AMI. A higher incidence was observed in the winter months, especially in January, in the early morning hours.…”

Section: Discussionmentioning

confidence: 69%

Influence of circadian rhythms and seasonal and annual variations on acute myocardial infarction incidence

Marić,

Đuričin,

Jokšić-Mazinjanin

et al. 2023

Scripta Medica

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Background/Aim: Acute myocardial infarction (AMI) is a consequence of complete coronary artery occlusion. There is a considerable seasonal variation in the incidence of AMI. The aim of the study was to establish a circadian and seasonal pattern of AMI. Methods: A retrospective observational study was conducted, using the database of the Institute of Emergency Medical Service of the City of Novi Sad. The study included 982 patients, both male and female, diagnosed with AMI (I.21 - ICD-10 code) in the period between 15 March 2018 and 14 March 2022. Data were classified according to the time of the day, days of the week, quarters and months. Data were analysed by using descriptive statistical methods, Mann-Whitney U test, Chi-squared test and Fisher's exact test. Results: AMI most frequently occurred between 6 am and 2 pm (389; 39.6 %). A statistically significant incidence of AMI was calculated for the periods between 6 am and 2 pm (ch2 = 39.69; p < 0.001) and between 2 pm and 10 pm (ch2 = 28.06; p < 0.001). Most cases of AMI were noted on Monday (153; 15.6 %) and in January (93; 9.5 %). The highest incidence of AMI was in the period between 15 March 2021 and 14 March 2022 (304; 31.0 %), while the lowest incidence was noted between 15 March 2019 and 14 March 2020 (190; 19.3 %). Conclusion: Circadian, seasonal and annual rhythm may have a significant impact on the incidence of AMI. This fact can have an important role in the prevention, timely recognition and adequate treatment of acute coronary disease.

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Section: Discussionmentioning

confidence: 69%

Influence of circadian rhythms and seasonal and annual variations on acute myocardial infarction incidence

Marić,

Đuričin,

Jokšić-Mazinjanin

et al. 2023

Scripta Medica

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“…When the SARS-CoV-2 virus binds with ACE2 receptors, it leads to the downregulation of these receptors, and this increases the activity of angiotensin II. This mechanism results in systemic vasoconstriction, apoptosis, inflammation, and endothelial proliferation, leading to cardiomyocyte damage or the worsening of previous ischemic condition [27]. Another identified mechanism of acute myocardial infarction in COVID-19 patients is coronary embolism, found in 3% of AMI patients [28].…”

Section: Discussionmentioning

confidence: 99%

Acute Myocardial Infarction during the COVID-19 Pandemic: Long-Term Outcomes and Prognosis—A Systematic Review

Rus,

Ardelean,

Andronie-Cioara

et al. 2024

Life

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Coronavirus disease 2019 (COVID-19) was a global pandemic with high mortality and morbidity that led to an increased health burden all over the world. Although the virus mostly affects the pulmonary tract, cardiovascular implications are often observed among COVID-19 patients and are predictive of poor outcomes. Increased values of myocardial biomarkers such as troponin I or NT-proBNP were proven to be risk factors for respiratory failure. Although the risk of acute coronary syndromes (ACSs) was greater in the acute phase of COVID-19, there were lower rates of hospitalization for ACSs, due to patients’ hesitation in presenting at the hospital. Hospitalized ACSs patients with COVID-19 infection had a prolonged symptom-to-first-medical-contact time, and longer door-to-balloon time. The mechanisms of myocardial injury in COVID-19 patients are still not entirely clear; however, the most frequently implicated factors include the downregulation of ACE2 receptors, endothelial dysfunction, pro-coagulant status, and increased levels of pro-inflammatory cytokines. The aim of this paper is to evaluate the long-term outcomes and prognosis of COVID-19 survivors that presented an acute myocardial infarction, by reviewing existing data. The importance of the association between this infectious disease and myocardial infarction arises from the increased mortality of patients with SARS-CoV-2 infection and AMI (10–76%, compared with 4.6% for NSTEMI patients and 7% for STEMI patients without COVID-19). The literature review showed an increased risk of cardiovascular events in COVID-19 survivors compared with the general population, even after the acute phase of the disease, with poorer long-term outcomes.

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“…In case of GCM, there have also been reported cases or an association between this type of myocarditis and infections involving Coxsackie type B and Parvovirus B19 viruses (46,47). Myocardial damage accompanied by elevated hsTnI values is often registered in patients with Covid-19 infection (48). Amiri A. and colleagues described a case of GCM in a patient with Covid-19 infection (49).…”

Section: Histopathological Findings Potential Etiological Factors And...mentioning

confidence: 99%

Giant cell myocarditis in modern clinical practice

Lasica,

Đukanović,

Zdravković

et al. 2023

Medicinska istraživanja

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Giant cell myocarditis is a rare but extremely severe disease with a frequent need for heart transplantation and a high mortality rate. To this day, the most common reason for the occurrence of this disease has not been precisely determined, but its frequent association with autoimmune diseases speaks in favor of autoimmune etiology. Clinically, it is presented to the greatest extent by symptoms and signs of acute heart failure and ventricular rhythm disturbances, which are registered in as many as half of the patients. Arrhythmias can be accompanied by the occurrence of palpitations, repeated syncope, and even sudden cardiac death. A severe degree of acute heart failure in hemodynamically unstable patents who respond inadequately to the administered therapy for heart failure and refractory heart rhythm disorders and/or conduction disorders that are common in these patients should always raise suspicion of giant cell myocarditis. Given that changes in electrocardiogram, echocardiography and positive biomarker values are not strictly specific for this disease, the diagnosis of giant cell myocarditis is most often established by endomyocardial biopsy, especially in patients with the fulminant form of the disease. Timely endomyocardial biopsy enables not only quick and accurate diagnosis, but also early administration of immunosuppressive therapy, which greatly improves the outcome in these patients. Pathohistological verification of this disease is important so as to rule out cardiac sarcoidosis and other granulomatous infectious and non-infectious diseases. Given that in a large number of patients the disease has a fulminant course, early and rapid diagnosis, application of inotropic stimulation and mechanical circulatory support in hemodynamically unstable patients and adequate modern therapeutic regimen can largely reduce mortality in these patients, which is still high despite modern diagnostics and therapeutic progress of medicine.

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Acute Coronary Syndrome in the COVID-19 Era—Differences and Dilemmas Compared to the Pre-COVID-19 Era

Cited by 15 publications

References 121 publications

Influence of circadian rhythms and seasonal and annual variations on acute myocardial infarction incidence

Influence of circadian rhythms and seasonal and annual variations on acute myocardial infarction incidence

Acute Myocardial Infarction during the COVID-19 Pandemic: Long-Term Outcomes and Prognosis—A Systematic Review

Giant cell myocarditis in modern clinical practice

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