Reduction in ST-Segment Elevation Cardiac Catheterization Laboratory Activations in the United States During COVID-19 Pandemic

García, Santiago; Albaghdadi, Mazen; Meraj, Perwaiz; Schmidt, Christian; Garberich, Ross; Jaffer, Farouc A.; Dixon, Simon; Rade, Jeffrey J.; Tannenbaum, Mark; Chambers, Jenny; Huang, Paul P.; Henry, Timothy D.

doi:10.1016/j.jacc.2020.04.011

Cited by 1,032 publications

(1,098 citation statements)

References 4 publications

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“…6 In addition, there has been a reduction in STEMI activations, reflecting a reluctance to seek medical attention or misdiagnoses given the focus on respiratory issues. 11 Given this complexity, a reassessment of the current strategies for efficient and effective management of AMI during the COVID-19 pandemic is required. This is addressed with a focus on 1) clinical presentation including STEMI, cardiogenic shock, out-of-hospital cardiac arrest (OHCA), and non-STEMI; 2) PPE for health care workers; 3) role of the ED, EMS and CCL; and 4) Regional STEMI systems of care.…”

Section: Methodsmentioning

confidence: 99%

Management of Acute Myocardial Infarction During the COVID-19 Pandemic

Mahmud

Dauerman

Welt

et al. 2020

Journal of the American College of Cardiology

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350

194

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The worldwide pandemic caused by the novel acute respiratory syndrome coronavirus 2 (SARS-CoV2) has resulted in a new and lethal disease termed coronavirus disease 2019 . Although there is an association between cardiovascular disease and COVID-19, the majority of patients who need cardiovascular care for the management of ischemic heart disease may not be infected with COVID-19. The objective of this document is to provide recommendations for a systematic approach for the care of patients with an acute myocardial infarction (AMI) during the COVID-19 pandemic. There is a recognition of two major challenges in providing recommendations for AMI care in the COVID-19 era. Cardiovascular manifestations of COVID-19 are complex with patients presenting with AMI, myocarditis simulating a STelevation MI presentation, stress cardiomyopathy, non-ischemic cardiomyopathy, coronary spasm, or nonspecific myocardial injury and the prevalence of COVID-19 disease in the US population remains unknown with risk of asymptomatic spread. This document addresses the care of these patients focusing on 1) the varied clinical presentations; 2) appropriate personal protection equipment (PPE) for health care workers; 3) role of the Emergency Department, Emergency Medical System and the Cardiac Catheterization Laboratory; and 4) Regional STEMI systems of care. During the COVID-19 pandemic, primary PCI remains the standard of care for STEMI patients at PCI capable hospitals when it can be provided in a timely fashion, with an expert team outfitted with PPE in a dedicated CCL room. A fibrinolysis-based strategy may be entertained at non-PCI capable referral hospitals or in specific situations where primary PCI cannot be executed or is not deemed the best option.

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Section: Methodsmentioning

confidence: 99%

Management of Acute Myocardial Infarction During the COVID-19 Pandemic

Mahmud

Dauerman

Welt

et al. 2020

Journal of the American College of Cardiology

Self Cite

350

194

View full text Add to dashboard Cite

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“…Another noteworthy feature of COVID-19 for cardiologists is the significant decrease in the rates of hospital admissions for acute coronary syndromes which has been reported both in Italy [134] and US [135] during the COVID-19 outbreak, and despite being initially attributed to reduced air pollution, better adherence to treatment, or absence of occupational stress during lockdown, this phenomenon seems to be most likely due to the fear of going to the hospital and/or seeking medical attention during a pandemic. Unfortunately, the current decline in hospitalization for acute coronary syndromes will trigger an increase in cases of heart failure in the near future.…”

Section: Ace2 and Anti-hypertensive Drugs: What Do We Know?mentioning

confidence: 99%

Hypertension, Thrombosis, Kidney Failure, and Diabetes: Is COVID-19 an Endothelial Disease? A Comprehensive Evaluation of Clinical and Basic Evidence

Sardu

Gambardella

Morelli

et al. 2020

JCM

443

412

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The symptoms most commonly reported by patients affected by coronavirus disease (COVID-19) include cough, fever, and shortness of breath. However, other major events usually observed in COVID-19 patients (e.g., high blood pressure, arterial and venous thromboembolism, kidney disease, neurologic disorders, and diabetes mellitus) indicate that the virus is targeting the endothelium, one of the largest organs in the human body. Herein, we report a systematic and comprehensive evaluation of both clinical and preclinical evidence supporting the hypothesis that the endothelium is a key target organ in COVID-19, providing a mechanistic rationale behind its systemic manifestations.

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“…For example, emerging research indicates, a 38% reduction in the activation of the cardiac catheterization laboratory for acute myocardial infarction at some centers. 5 The decrease is likely due to people delaying medical attention for cardiac symptoms out of concern for becoming infected with COVID-19. Although systematic data are currently unavailable, other vulnerable groups, including those of lower socioeconomic status, low health literacy, undocumented immigrants and non-English speakers are also likely at differential increased risk due to delayed presentations.…”

Section: Clinical Presentationmentioning

confidence: 99%