COVID-19 and Acute Coronary Syndromes: Current Data and Future Implications

Abstract

Coronavirus disease-2019 (COVID-19) pandemic is a global healthcare burden, characterized by high mortality and morbidity rates all over the world. During the outbreak period, the topic of acute coronary syndromes (ACS) has raised several clinical issues, due to the risks of COVID-19 induced myocardial injury and to the uncertainties about the management of these cardiologic emergency conditions, which should be organized optimizing the diagnostic and therapeutic resources and ensuring the maximum protection to healthcare personnel and hospital environment. COVID-19 status should be assessed as soon as possible. Moreover, considerably lower rates of hospitalization for ACS have been reported all over the world, due to patients' hesitations to refer to hospital and to missed diagnosis. As a result, short- and long-term complications of myocardial infarction are expected in the near future; therefore, great efforts of healthcare providers will be required to limit the effects of this issue. In the present review we discuss the impact of COVID-19 pandemic on ACS diagnosis and management, with possible incoming consequences, providing an overview of the available evidence and suggesting future changes in social and clinical approach to ACS.

COVID-19, Acute Myocardial Injury, and Infarction

“…Patients with COVID-19 that in addition experience a STEMI or very high risk NSTEMI should be referred to the cathlab within the timeframe suggested by the current guidelines. Fibrinolysis should be considered only in case of difficulties in patients' transfer to a hub center in order to perform timely PCIs (66,67).…”

COVID-19 Severity and Cardiovascular Disease: An Inseparable Link

“…The fourth article addresses an important in-hospital issue, which is the outcome of STelevation myocardial infarction, hence impacting the national health services and national health systems. Our hospital admission analysis showed a trend toward a reduction in acute coronary syndromes incidence, with a substantial increase in STEMI fatality rate and complications during the pandemic, compared with 2019 [8]. This was explained by the decrease in percutaneous coronary intervention (PCI) procedures [9], with an annual 634 PCI patients falling by 25.7% during the COVID-19 period (mean 30.0 ± 4.01 vs. 40.4 ± 5.3 case/month) and prolongation of the time from first medical contact to needle (125.0 ± 53.6 vs. 52.6 ± 22.8 min, p = 0.001).…”

Acute Myopericarditis after COVID-19 Vaccine in Teenagers

“…The incidence of acute coronary syndromes in children and young adolescents is very rare compared to middle-aged and elderly patients [ 17 ]. There have been multiple case reports of acute coronary syndrome associated with COVID-19 in adults who required invasive coronary angiography but no reports of coronary involvement in any patients who received COVID-19 vaccine so far [ 18 ]. Rosner et al [ 16 ] performed coronary angiography in 3 out of 7 middle-aged patients with COVID-19 vaccine-associated myocarditis, and none of them revealed any obstructive coronary disease, and all of them were early or middle-aged patients.…”