Experience of ST Segment Elevation Myocardial Infarction Management During COVID-19 Pandemic From the Mainland of China

Zhang, Feifei; Dang, Yi

doi:10.1016/j.carrev.2020.07.027

Cited by 11 publications

(9 citation statements)

References 10 publications

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“…Zhang et al 18 China Monocentric Good 395 n/a n/a n/a n/a n/a n/a n/a NIH: study quality as per the National Institutes of Health (NIH) Quality Assessment Tool. *Claeys et al: 16 baseline characteristics of 595 patients were assessed.…”

Section: Discussionmentioning

confidence: 99%

“…For instance, the Hebei Province was one of four provinces (Hebei, Hubei, Beijing, Tianjin) in China to Coronary artery disease maintain the national state of emergency the longest, thereby potentially contributing to a longer time to FMC. 18 Furthermore, studies from medical centres located in COVID-19 hot spots such as Milan, Italy, reported the most delayed FMC during the COVID-19 outbreak, suggesting a huge impact of local factors, such as fear, lockdown and possibly COVID-19-related structural deficits of the emergency care system. 8 15 Remarkably, the three studies included in our meta-analysis on time to FMC observing the largest prolonging effect of COVID-19 on FMC all derived from single centres, possibly accentuating local influences.…”

Section: Time To Fmcmentioning

confidence: 99%

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Effect of the COVID-19 pandemic on mortality of patients with STEMI: a systematic review and meta-analysis

Rattka

Dreyhaupt

Winsauer

et al. 2020

Heart

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AimsSince the beginning of the SARS-CoV-2 outbreak, hospitals reported declining numbers of patients admitted with ST-segment elevation myocardial infarction (STEMI), indicating that the pandemic might keep patients from seeking urgent medical treatment. However, data on outcomes and mortality rates are inconsistent between studies.MethodsA literature search and meta-analysis were performed on studies reporting the mortality of patients with STEMI admitted before and during the COVID-19 pandemic using PubMed, Embase and Web of Science. Additionally, prehospital and intrahospital delay times were evaluated.ResultsOutcomes of a total of 50 123 patients from 10 studies were assessed. Our study revealed that, despite a significant reduction in overall admission rates of patients with STEMI during the COVID-19 pandemic (incidence rate ratio=0.789, 95% CI 0.730 to 0.852, I2=77%, p<0.01), there was no significant difference in hospital mortality (OR=1.178, 95% CI 0.926 to 1.498, I2=57%, p=0.01) compared with patients with STEMI admitted before the outbreak. Time from the onset of symptoms to first medical contact was similar (mean difference (MD)=33.4 min, 95% CI −10.2 to 77.1, I2=88%, p<0.01) while door-to-balloon time was significantly prolonged in those presenting during the pandemic (MD=7.3 min, 95% CI 3.0 to 11.7, I2=95%, p<0.01).ConclusionThe significant reduction in admission of patients with STEMI was not associated with a significant increase of hospital mortality rates. The causes for reduced incidence rates remain speculative. However, the analysed data indicate that acute and timely medical care of these patients has been maintained during the pandemic in most countries. Long-term data on mortality have yet to be determined.

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Section: Discussionmentioning

confidence: 99%

Section: Time To Fmcmentioning

confidence: 99%

Effect of the COVID-19 pandemic on mortality of patients with STEMI: a systematic review and meta-analysis

Rattka

Dreyhaupt

Winsauer

et al. 2020

Heart

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“…130 Similarly, a study from China indicated a 51.4% decrease in hospital admissions of STEMI patients during the peak period of COVID-19 epidemic. 131 Importantly, lack of reperfusion therapy for STEMI patients was >10% higher in 2020 than the previous 2 years; 2-3 times more STEMI patients received fibrinolysis in 2020 than the 2 previous years, while the volume of primary PCI dropped by more than half. This led to highest mortality rate recorded in February 2020.…”

Section: Patient Delay In Seeking Care and Visiting The Emergency Department/re-emergence Of Post-mi Mechanical And Other Complications Imentioning

confidence: 99%

“…81 Thus, there is a reduced number of admissions for ACS but also a significant delay in ACS presentation consistently reported during the COVID-19 pandemic era. 7,130,131,136 There is fear supported by important preliminary evidence that this observed pattern may lead to increases in OOHCA, acute mechanical and long-term complications of MI and missed chance to implement secondary prevention therapies for patients with CAD. 127,128,135,136…”

Section: Patient Delay In Seeking Care and Visiting The Emergency Department/re-emergence Of Post-mi Mechanical And Other Complications Imentioning

confidence: 99%

COVID-19 and Acute Myocardial Injury and Infarction: Related Mechanisms and Emerging Challenges

Manolis¹,

Manolis

et al. 2021

J Cardiovasc Pharmacol Ther

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In the era of the coronavirus disease 2019 (COVID-19) pandemic, acute cardiac injury (ACI), as reflected by elevated cardiac troponin above the 99th percentile, has been observed in 8%-62% of patients with COVID-19 infection with highest incidence and mortality recorded in patients with severe infection. Apart from the clinically and electrocardiographically discernible causes of ACI, such as acute myocardial infarction (MI), other cardiac causes need to be considered such as myocarditis, Takotsubo syndrome, and direct injury from COVID-19, together with noncardiac conditions, such as pulmonary embolism, critical illness, and sepsis. Acute coronary syndromes (ACS) with normal or near-normal coronary arteries (ACS-NNOCA) appear to have a higher prevalence in both COVID-19 positive and negative patients in the pandemic compared to the pre-pandemic era. Echocardiography, coronary angiography, chest computed tomography and/or cardiac magnetic resonance imaging may render a correct diagnosis, obviating the need for endomyocardial biopsy. Importantly, a significant delay has been recorded in patients with ACS seeking advice for their symptoms, while their routine care has been sharply disrupted with fewer urgent coronary angiographies and/or primary percutaneous coronary interventions performed in the case of ST-elevation MI (STEMI) with an inappropriate shift toward thrombolysis, all contributing to a higher complication rate in these patients. Thus, new challenges have emerged in rendering a diagnosis and delivering treatment in patients with ACI/ACS in the pandemic era. These issues, the various mechanisms involved in the development of ACI/ACS, and relevant current guidelines are herein reviewed.

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“…Another study conducted in China showed that the number of primary percutaneous coronary intervention (PCI) dropped by more than a half in the first three months of 2020 compared to 2018 and 2019, while the number of patients treated with fibrinolysis increased by 2 to 3 times. Also in this study, a longer time to reperfusion was reported among patients treated in 2020 [ 28 ].…”

Section: The Epidemiology Paradox Of Acs In Covid-19mentioning

confidence: 62%

COVID‐19 and Acute Coronary Syndromes: From Pathophysiology to Clinical Perspectives

Esposito

Cancro

Silverio

et al. 2021

Oxidative Medicine and Cellular Longevity

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Acute coronary syndromes (ACS) are frequently reported in patients with coronavirus disease 2019 (COVID-19) and may impact patient clinical course and mortality. Although the underlying pathogenesis remains unclear, several potential mechanisms have been hypothesized, including oxygen supply/demand imbalance, direct viral cellular damage, systemic inflammatory response with cytokine-mediated injury, microvascular thrombosis, and endothelial dysfunction. The severe hypoxic state, combined with other conditions frequently reported in COVID-19, namely sepsis, tachyarrhythmias, anemia, hypotension, and shock, can induce a myocardial damage due to the mismatch between oxygen supply and demand and results in type 2 myocardial infarction (MI). In addition, COVID-19 promotes atherosclerotic plaque instability and thrombus formation and may precipitate type 1 MI. Patients with severe disease often show decrease in platelets count, higher levels of d-dimer, ultralarge von Willebrand factor multimers, tissue factor, and prolongation of prothrombin time, which reflects a prothrombotic state. An endothelial dysfunction has been described as a consequence of the direct viral effects and of the hyperinflammatory environment. The expression of tissue factor, von Willebrand factor, thromboxane, and plasminogen activator inhibitor-1 promotes the prothrombotic status. In addition, endothelial cells generate superoxide anions, with enhanced local oxidative stress, and endothelin-1, which affects the vasodilator/vasoconstrictor balance and platelet aggregation. The optimal management of COVID-19 patients is a challenge both for logistic and clinical reasons. A deeper understanding of ACS pathophysiology may yield novel research insights and therapeutic perspectives in higher cardiovascular risk subjects with COVID-19.

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Experience of ST Segment Elevation Myocardial Infarction Management During COVID-19 Pandemic From the Mainland of China

Cited by 11 publications

References 10 publications

Effect of the COVID-19 pandemic on mortality of patients with STEMI: a systematic review and meta-analysis

Effect of the COVID-19 pandemic on mortality of patients with STEMI: a systematic review and meta-analysis

COVID-19 and Acute Myocardial Injury and Infarction: Related Mechanisms and Emerging Challenges

COVID‐19 and Acute Coronary Syndromes: From Pathophysiology to Clinical Perspectives

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