tetano
Editor, Senior Moderator
J Am Coll Cardiol. 2020 Apr 18. pii: S0735-1097(20)35026-9. doi: 10.1016/j.jacc.2020.04.039. [Epub ahead of print]
Management of Acute Myocardial Infarction During the COVID-19 Pandemic.
Mahmud E[SUP]1[/SUP], Dauerman HL[SUP]2[/SUP], Welt FG[SUP]3[/SUP], Messenger JC[SUP]4[/SUP], Rao SV[SUP]5[/SUP], Grines C[SUP]6[/SUP], Mattu A[SUP]7[/SUP], Kirtane AJ[SUP]8[/SUP], Jauhar R[SUP]9[/SUP], Meraj P[SUP]10[/SUP], Rokos IC[SUP]11[/SUP], Rumsfeld JS[SUP]12[/SUP], Henry TD[SUP]13[/SUP].
Author information
Abstract
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 (COVID-19). 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 ST-elevation 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.
Copyright ? 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
KEYWORDS:
COVID-19; STEMI; acute myocardial infarction; emergency medical system; fibrinolysis; percutaneous coronary intervention
PMID:32330544DOI:10.1016/j.jacc.2020.04.039
Management of Acute Myocardial Infarction During the COVID-19 Pandemic.
Mahmud E[SUP]1[/SUP], Dauerman HL[SUP]2[/SUP], Welt FG[SUP]3[/SUP], Messenger JC[SUP]4[/SUP], Rao SV[SUP]5[/SUP], Grines C[SUP]6[/SUP], Mattu A[SUP]7[/SUP], Kirtane AJ[SUP]8[/SUP], Jauhar R[SUP]9[/SUP], Meraj P[SUP]10[/SUP], Rokos IC[SUP]11[/SUP], Rumsfeld JS[SUP]12[/SUP], Henry TD[SUP]13[/SUP].
Author information
Abstract
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 (COVID-19). 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 ST-elevation 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.
Copyright ? 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
KEYWORDS:
COVID-19; STEMI; acute myocardial infarction; emergency medical system; fibrinolysis; percutaneous coronary intervention
PMID:32330544DOI:10.1016/j.jacc.2020.04.039