Management of <scp>ST‐segment‐elevation</scp> myocardial infarction during the coronavirus disease 2019 (<scp>COVID</scp>‐19) outbreak: Iranian“247” National Committee's position paper on primary percutaneous coronary intervention

Sadeghipour, Parham; Talasaz, Azita Hajhossein; Eslami, Vahid; Geraiely, Babak; Vojdanparast, Mohammad; Sedaghat, Mojtaba; Moosavi, Abouzar Fakhr; Parsa, Saeed; Aminian, B; Firouzi, Ata; Ghaffari, Samad; Ghasemi, Mahshid; Saleh, Davood Kazemi; Khosravi, Alireza; Kojuri, Javad; Noohi, Feridoun; Pourhosseini, Hamidreza; Salarifar, Mojtaba; Salehi, Mohamad Reza; Sezavar, H; Shabestari, Mahmood; Soleimani, Abbas; Tabarsi, Payam; Parsa, Amir Farhang Zand; Abdi, Seifollah

doi:10.1002/ccd.28889

Cited by 23 publications

(30 citation statements)

References 20 publications

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“…Organizations or experts in the United States, Italy, Australia, and New Zealand have mostly recommended continuing with existing primary PCI protocols for STEMI patients except for confirmed COVID-19 patients and persons under investigation or cases in which primary PCI could not be performed within required time frames ( 10 , 11 , 12 , 13 ). In contrast, experts in China, Iran, Palestine, and Jordan recommended prioritizing thrombolytic treatment for most patients with unconfirmed COVID-19 status ( 14 , 15 , 16 ).…”

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confidence: 99%

Management and Outcomes of Patients With STEMI During the COVID-19 Pandemic in China

Xiang

Zhang

et al. 2020

Journal of the American College of Cardiology

189

217

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Background ST-segment elevation myocardial infarction (STEMI) is a fatal cardiovascular emergency requiring rapid reperfusion treatment. During the coronavirus disease-2019 (COVID-19) pandemic, medical professionals need to strike a balance between providing timely treatment for STEMI patients and implementing infection control procedures to prevent nosocomial spread of COVID-19 among health care workers and other vulnerable cardiovascular patients. Objectives This study evaluates the impact of the COVID-19 outbreak and China Chest Pain Center’s modified STEMI protocol on the treatment and prognosis of STEMI patients in China. Methods Based on the data of 28,189 STEMI patients admitted to 1,372 Chest Pain Centers in China between December 27, 2019 and February 20, 2020, the study analyzed how the COVID-19 outbreak and China Chest Pain Center’s modified STEMI protocol influenced the number of admitted STEMI cases, reperfusion strategy, key treatment time points, and in-hospital mortality and heart failure for STEMI patients. Results The COVID-19 outbreak reduced the number of STEMI cases reported to China Chest Pain Centers. Consistent with China Chest Pain Center’s modified STEMI protocol, the percentage of patients undergoing primary percutaneous coronary intervention declined while the percentage of patients undergoing thrombolysis increased. With an average delay of approximately 20 min for reperfusion therapy, the rate of in-hospital mortality and in-hospital heart failure increased during the outbreak, but the rate of in-hospital hemorrhage remained stable. Conclusions There were reductions in STEMI patients’ access to care, delays in treatment timelines, changes in reperfusion strategies, and an increase of in-hospital mortality and heart failure during the COVID-19 pandemic in China.

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confidence: 99%

Management and Outcomes of Patients With STEMI During the COVID-19 Pandemic in China

Xiang

Zhang

et al. 2020

Journal of the American College of Cardiology

189

217

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“…Different scientific societies have released recommendations on choice of reperfusion treatment during COVID-19 outbreak. The Chinese Society of Cardiology (CSC) and the Iranian 247 PPCI Committee recommended thrombolysis as first choice of treatment [ 7 , 8 ], While the EAPCI and ACC/SCAI statement continue to recommend PPCI as the standard treatment of STEMI patients during the current pandemic [ 9 , 10 ]. All STEMI patients should undergo testing for COVID-19 and be considered potentially COVID-19 positive during reperfusion therapy.…”

Section: Discussionmentioning

confidence: 99%

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

Zhang

Dang

2021

Cardiovascular Revascularization Medicine

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Background The pandemic of COVID-19 has created a crisis in healthcare systems across the globe. This situation would affect the diagnosis and treatment of patients with STEMI. The outbreak was under improved control in the mainland of China. We here describe the impact of this pandemic on STEMI patient's management. Methods Information of STEMI patient management was collected from the CPC data reporting platform. We compared these with data of patients from the same period in 2018 and 2019. Also we made an analysis of those characteristics in each month in 2020. Results There was 51.4% decrease of STEMI patients admitted to hospital during the peak period of COVID-19 epidemic. The ratio of no reperfusion of STEMI patients is more than 10% higher in 2020 than 2018, 2019. The percentage of STEMI patients received fibrinolysis in 2020 was 2 to 3 times higher than that in 2018, 2019, while the volume of PPCI dropped by more than half. The mortality rate of whole cohort and perioperative was the highest in February 2020. Conclusions COVID-19 pandemic dramatically reduced the number of STEMI patients attending hospital and delay the time to treatment and consequently, a higher in-hospital mortality. The benefits of thrombolysis during the pandemic remain to be proven.

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“…Similarly, while primary PCI has long replaced thrombolytic therapy as standard of care in the United States, 10 the new challenges of COVID‐19 have at least temporarily made it an option at primary PCI centers 11 . However, our practice patterns have not mirrored more thrombolytic heavy strategies adopted in China and other countries, 12,13 Many practicing interventionalists in the United States trained in the primary PCI era, with minimal direct experience with thrombolytics or late presentation myocardial infarctions, which could impact management and patient outcomes during this period.…”

Section: Discussionmentioning

confidence: 99%

Cardiac procedural deferral during the coronavirus (COVID‐19) pandemic

Yong

Ang

Welt

et al. 2020

Cathet Cardio Intervent

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We aimed to examine factors impacting variability in cardiac procedural deferral during the COVID‐19 pandemic and assess cardiologists' perspectives regarding its implications. Unprecedented cardiac procedural deferral was implemented nationwide during the COVID‐19 pandemic. A web‐based survey was administered by Society for Cardiovascular Angiography and Interventions and the American College of Cardiology Interventional Council to cardiac catheterization laboratory (CCL) directors and interventional cardiologists across the United States during the COVID‐19 pandemic. Among 414 total responses, 48 states and 360 unique cardiac catheterization laboratories were represented, with mean inpatient COVID‐19 burden 16.4 ± 21.9%. There was a spectrum of deferral by procedure type, varying by both severity of COVID‐19 burden and procedural urgency (p < .001). Percutaneous coronary intervention volumes dropped by 55% (p < .0001) and transcatheter aortic valve replacement volumes dropped by 64% (p = .004), with cardiologists reporting an increase in late presenting ST‐elevation myocardial infarctions and deaths among patients waiting for transcatheter aortic valve replacement. Almost 1/3 of catheterization laboratories had at least one interventionalist testing positive for COVID‐19. Salary reductions did not influence procedural deferral or speed of reinstituting normal volumes. Pandemic preparedness improved significantly over time, with the most pressing current problems focused on inadequate testing and staff health risks. During the COVID‐19 pandemic, cardiac procedural deferrals were associated with procedural urgency and severity of hospital COVID‐19 burden. Yet patients did not appear to be similarly influenced, with cardiologists reporting increases in late presenting ST‐elevation myocardial infarctions independent of local COVID‐19 burden. The safety and importance of seeking healthcare during this pandemic deserves emphasis.

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Management of ST‐segment‐elevation myocardial infarction during the coronavirus disease 2019 (COVID‐19) outbreak: Iranian“247” National Committee's position paper on primary percutaneous coronary intervention

Cited by 23 publications

References 20 publications

Management and Outcomes of Patients With STEMI During the COVID-19 Pandemic in China

Management and Outcomes of Patients With STEMI During the COVID-19 Pandemic in China

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

Cardiac procedural deferral during the coronavirus (COVID‐19) pandemic

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