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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leading to the novel coronavirus disease 2019 (COVID-19) pandemic was first reported in Wuhan, Hubei Province, China. 1 The first cases emerged in late December 2019 rapidly spreading throughout China and beyond, leading to increasing rates of morbidity and mortality worldwide. 2 SARS-CoV-2 is the seventh member of the coronaviruses family that is known to infect humans. 1 As of May 24, 2020, the number of cases exceeds 5 million worldwide accounting for over 337,000 deaths. 3 The COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) reported in April 2020 that approximately 92% of hospitalized patients with COVID-19 had at least one co-morbid condition. The most common associated conditions with COVID-19 among hospitalized patients are hypertension, obesity, and underlying cardiovascular disease. 4 Chronic immunosuppression accounts for approximately 10% of the patients hospitalized. Given the state

The TRAPID-AMI (High Sensitivity Cardiac Troponin T assay for rapid Rule-out of Acute Myocardial Infarction) study evaluated a rapid “rule-out” acute myocardial infarction (AMI). We evaluated what symptoms were associated with AMI as part of a substudy of TRAPID-AMI. There were 1282 patients evaluated from 12 centers in Europe, the United States of America, and Australia from 2011 to 2013. Multiple symptom variables were prospectively obtained and evaluated for association with the final diagnosis of AMI. Multivariate logistic regression analysis was done, and odds ratios (OR) were calculated. There were 213/1282 (17%) AMIs. Four independent predictors for the diagnosis of AMI were identified: radiation to right arm or shoulder [OR = 3.0; confidence interval (CI): 1.8–5.0], chest pressure (OR = 2.5; CI: 1.3–4.6), worsened by physical activity (OR = 1.7; CI: 1.2–2.5), and radiation to left arm or shoulder (OR = 1.7; CI: 1.1–2.4). In the entire group, 131 (10%) had radiation to right arm or shoulder, 897 (70%) had chest pressure, 385 (30%) worsened with physical activity, and 448 (35%) had radiation to left arm or shoulder. Duration of symptoms was not predictive of AMI. There were no symptoms predictive of non-AMI. Relationship between AMI size and symptoms was also studied. For 213 AMI patients, cardiac troponins I values were divided into 4 quartiles. Symptoms including pulling chest pain, supramammillary right location, and right arm/shoulder radiation were significantly more likely to occur in patients with larger AMIs. In a large multicenter trial, only 4 symptoms were associated with the diagnosis of AMI, and no symptoms that were associated with a non-AMI diagnosis.

The evaluation of individuals with possible acute myocardial infarction (AMI) is time consuming and costly. Risk stratification early during an acute care encounter presents an opportunity for increased delivery of high-value care. We sought to evaluate if the HEART score could be used in the triage of low-risk versus high-risk patients directly home without cardiac testing. Retrospective review of 838 patients placed in an observation unit for evaluation of AMI was done at a single-center, tertiary care teaching hospital. Primary outcome was major adverse cardiac event—death, AMI, or revascularization—at 30 days from the index encounter. Participants’ average age was 60.1 years, 40% were male, and 67% were African American. Complete data were available for all 838 patients, including 30-day follow-up at study completion. The primary endpoint was met in 14 patients (1.7%), all of whom were in the high-risk group, with HEART score ≥4. Of the low-risk patients, 8 (2.8%) had a positive functional study, 5 underwent subsequent coronary angiography, with none (0%) found to have obstructive coronary disease. In conclusion, our results suggest that patients with a HEART score ≤3 being evaluated for chest pain are at extremely low risk for major adverse cardiac events and may be safely discharged without provocative testing. Positive cardiac testing in this population is more likely to represent a false-positive finding, resulting in unnecessary testing. These findings should be prospectively validated.