Management of acute coronary syndrome in the context of coronavirus disease 2019

Abstract

Coronavirus disease 2019 (COVID-19) is still developing worldwide. The prognosis of the disease will become worse and mortality will be even higher when it is combined with cardiovascular disease. Furthermore, COVID-19 is highly infectious and requires strict isolation measures. For acute coronary syndromes (ACS), a common cardiovascular disease, infection may aggravate the occurrence and development of ACS, making the management of more difficult. It will be an enormous challenge for clinical practice to deal with ACS in this setting of COVID-19. Aim to reduce the mortality of ACS patients during the epidemic of COVID-19 by standardizing procedures as much as possible. Pubmed and other relevant databases were searched to retrieve articles on COVID-19 and articles on ACS management strategies during previous influenza epidemics. The data was described and synthesized to summarize the diagnosis and management strategy of ACS, the preparation of catheter laboratory, and the protection of the medical staff in the context of COVID-19. Ethical approval is not required in this study, because it is a review with no recourse to patient identifiable information. Standardized diagnosis and treatment advice can help reduce the mortality of COVID-19 patients with ACS. In the absence of contraindications, the third generation of thrombolytic drugs should be the first choice for thrombolytic treatment in the isolation ward. For patients who have to receive PCI, this article provides detailed protective measures to avoid nosocomial infection.

Acute coronary syndrome with cardiogenic shock due to occlusion of right coronary artery in a young physician caring patients with COVID-19 infection: a case report

“…The guidelines are modified depending on logistics. Some center suggests thrombolytic therapy rather than primary PCI [1,2]. Thus, the practice for revascularization was found to be varied in different countries -rate of primary percutaneous coronary intervention was highest in the USA and lowest in Australia, New Zealand, and Canada explained to promote human and material resources optimization, infection prevention for patients and healthcare workers, and transfer times force prior to invasive management for ischaemic heart disease during the COVID 19 outbreak.…”

“…However, there are variations in treatment guideline for acute coronary syndrome in COVID era. A fibrinolysis-based strategy is preferable than primary PCI in some countries [1,2].…”

“…Thus, all patients must be screened for COVID-19 infection prior to procedure and delay in results for COVID-19 infection can lengthen "door to needle time". For patients who have to receive PCI, the detailed protective measures must be applied to avoid nosocomial infection [2]. There should be a dedicated Cath-lab for suspected COVID-19 cases and it is not easy for developing countries.…”

Effectiveness of nurse‐led counselling and education on self‐efficacy of patients with acute coronary syndrome: A randomized controlled trial

“…ACS-which encompasses three acute conditions, including ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI) and unstable angina-is the result of endothelial dysfunction or unstable atheromatous plaques with transient or permanent thrombotic blockage of the coronary artery, leading to myocardial ischaemia and infarction (Atherton et al, 2018;Collet et al, 2020). Patients with ACS typically suffer from multiple problems including pain (Chen et al, 2018), changes in the tissue blood flow (Liang et al, 2021), intolerance to physical activity (Rymuza et al, 2019), ineffective adaptation to the disease, and severe anxiety and depressive symptoms (Serrano-Rosa et al, 2021), which have a negative impact on patients' quality of life. The ideal management of ACS following the postacute period involves controlling risk factors such as diabetes, hypertension, atherogenic lipid profile, obesity and lifestyle modifications including promoting physical activity, dietary changes and smoking cessation (Bhagwat et al, 2016;Candelaria et al, 2020;Landmesser et al, 2020).…”