ST-Elevation Myocardial Infarction in Patients With COVID-19

Stefanini, Giulio G.; Montorfano, Matteo; Trabattoni, Daniela; Andreini, Daniele; Ferrante, Giuseppe; Ancona, Marco; Metra, Marco; Curello, Salvatore; Maffeo, Diego; Pero, Gaetano; Cacucci, Michele; Assanelli, Emilio; Bellini, Barbara; Russo, Filippo; Ielasi, Alfonso; Tespili, Maurizio; Danzi, Gian Battista; Vandoni, Pietro; Boccadoro, Mario; Barbieri, Lucia; Oreglia, Jacopo; Lettieri, Corrado; Cremonesi, Alberto; Carugo, Stefano; Reimers, Bernhard; Condorelli, Gianluigi; Chieffo, Alaide

doi:10.1161/circulationaha.120.047525

Cited by 385 publications

(411 citation statements)

References 5 publications

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“…In particular, there is a growing body of evidence worldwide demonstrating a significant decrease of up to 40% in the volume of patients presenting through PPCI services during the pandemic. 5 18–20 Our data support these findings with heart attack services in London experiencing a 21% decrease in cases compared with the same period in 2019. There could be a number of explanations for this observation.…”

Section: Discussionsupporting

confidence: 81%

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COVID-19 pandemic and STEMI: pathway activation and outcomes from the pan-London heart attack group

et al. 2020

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ObjectivesTo understand the impact of COVID-19 on delivery and outcomes of primary percutaneous coronary intervention (PPCI). Furthermore, to compare clinical presentation and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) with active COVID-19 against those without COVID-19.MethodsWe systematically analysed 348 STEMI cases presenting to the PPCI programme in London during the peak of the pandemic (1 March to 30 April 2020) and compared with 440 cases from the same period in 2019. Outcomes of interest included ambulance response times, timeliness of revascularisation, angiographic and procedural characteristics, and in-hospital clinical outcomesResultsThere was a 21% reduction in STEMI admissions and longer ambulance response times (87 (62–118) min in 2020 vs 75 (57–95) min in 2019, p<0.001), but that this was not associated with a delays in achieving revascularisation once in hospital (48 (34–65) min in 2020 vs 48 (35–70) min in 2019, p=0.35) or increased mortality (10.9% (38) in 2020 vs 8.6% (38) in 2019, p=0.28). 46 patients with active COVID-19 were more thrombotic and more likely to have intensive care unit admissions (32.6% (15) vs 9.3% (28), OR 5.74 (95%CI 2.24 to 9.89), p<0.001). They also had increased length of stay (4 (3–9) days vs 3 (2–4) days, p<0.001) and a higher mortality (21.7% (10) vs 9.3% (28), OR 2.72 (95% CI 1.25 to 5.82), p=0.012) compared with patients having PPCI without COVID-19.ConclusionThese findings suggest that PPCI pathways can be maintained during unprecedented healthcare emergencies but confirms the high mortality of STEMI in the context of concomitant COVID-19 infection characterised by a heightened state of thrombogenicity.

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Section: Discussionsupporting

confidence: 81%

“…Moreover, COVID-19 may have a significant impact on presentation, angiographic findings 5 6 and clinical outcomes of patients presenting with ST-segment elevation myocardial infarction (STEMI) through the PPCI pathway. 7 The systemic inflammatory response, induced by COVID-19, appears to disrupt antithrombotic mechanisms.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 pandemic and STEMI: pathway activation and outcomes from the pan-London heart attack group

et al. 2020

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“…Accordingly, ACC COVID‐19 clinical guidance pointed out that that classic symptoms and presentation of acute myocardial infarction may be unclear in the context of COVID‐19, resulting in underdiagnosis 13 . Moreover, in a small Italian report of 28 COVID‐19 patients with ST‐elevation myocardial infarction (STEMI), 78.6% of them presented with acute chest pain, while 82.1% had regional wall‐motion abnormalities at TTE 17 …”

Section: Suspected Acute Coronary Syndromesmentioning

confidence: 99%

Usefulness of echocardiography to detect cardiac involvement in COVID‐19 patients

et al. 2020

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Coronavirus disease 2019 (COVID‐19) outbreak is a current global healthcare burden, leading to the life‐threatening severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). However, evidence showed that, even if the prevalence of COVID‐19 damage consists in pulmonary lesions and symptoms, it could also affect other organs, such as heart, liver, and spleen. Particularly, some infected patients refer to the emergency department for cardiovascular symptoms, and around 10% of COVID‐19 victims had finally developed heart injury. Therefore, the use of echocardiography, according to the safety local protocols and ensuring the use of personal protective equipment, could be useful firstly to discriminate between primary cardiac disease or COVID‐19–related myocardial damage, and then for assessing and monitoring COVID‐19 cardiovascular complications: acute myocarditis and arrhythmias, acute heart failure, sepsis‐induced myocardial impairment, and right ventricular failure derived from treatment with high‐pressure mechanical ventilation. The present review aims to enlighten the applications of transthoracic echocardiography for the diagnostic and therapeutic management of myocardial damage in COVID‐19 patients.

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“…If PCI is pursued, appropriate personal protective equipment (PPE) for staff is mandatory, with full decontamination of the catheterization laboratory after completion of the procedure. 8 In a recent study published in Circulation, Stefanini et al 9 reported a review of their 29 COVID-19 patients with STEMI. Emergent coronary angiography confirmed culprit lesions in 60% of patients.…”

Section: Acute Coronary Syndromementioning

confidence: 99%

Coronavirus and Cardiovascular System

Parekh

Talwar

2020

Annals of the National Academy of Medical Sciences (India)

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With the pandemic of COVID-19 infection spreading throughout the world leading to unprecedented serious burden on healthcare, our understanding of the virus continues to grow on a daily basis with the whole world united to find a vaccine/cure to combat the disease. Clinical experience with growing number of cases has provided us with insight into the pathophysiology of the disease and the various systems of the body it affects. The growing experience shows that cardiovascular complications occur in significant number of cases and contribute to increased mortality. The complications and mortality is also higher in those with pre-existing cardiovascular disease. The pathogenesis of increased cardiac complications is possibly related to the action of virus surface spike proteins through ACE2 receptors expressed in the myocardium. Although various drugs/therapies are being tried currently, no effective therapy is still available. It is emphasized that those with existing cardiac disease should optimally take their medicines, and religiously follow preventive measures like social distancing, self-isolation and hand hygiene.

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ST-Elevation Myocardial Infarction in Patients With COVID-19

Cited by 385 publications

References 5 publications

COVID-19 pandemic and STEMI: pathway activation and outcomes from the pan-London heart attack group

COVID-19 pandemic and STEMI: pathway activation and outcomes from the pan-London heart attack group

Usefulness of echocardiography to detect cardiac involvement in COVID‐19 patients

Coronavirus and Cardiovascular System

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