Management of acute myocardial infarction during the <scp>COVID</scp>‐19 pandemic

Mahmud, Ehtisham; Dauerman, Harold L.; Welt, Frederick G.P.; Messenger, John C.; Rao, Sunil V.; Grines, Cindy L.; Mattu, Amal; Kirtane, Ajay J.; Jauhar, Rajiv; Meraj, Perwaiz; Rokos, Ivan C.; Rumsfeld, John S.; Henry, Timothy D.

doi:10.1002/ccd.28946

Cited by 137 publications

(96 citation statements)

References 26 publications

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“…All these factors together potentially increased time to first medical contact and caused a further delay in adequate medical therapy. Regarding the treatment of AMI with PCI as recommended by the guidelines, this could lead to a prolonged ischaemic time and therefore an increased mortality and worse cardiac outcome 11–14,22 . We could not observe any differences in our patients during the Covid‐19 pandemic regarding age, sex, or medical history including arterial hypertension, dyslipidaemia, known CADs with prior MI, PCI or CAGB, diabetes, obesity, heart failure, chronic kidney disease, and chronic obstructive pulmonary disease.…”

Section: Discussionmentioning

confidence: 74%

Increased mortality and worse cardiac outcome of acute myocardial infarction during the early COVID‐19 pandemic

2020

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Aims This study aimed to evaluate the impact of coronavirus disease 2019 (Covid-19) outbreak on admissions for acute myocardial infarction (AMI) and related mortality, severity of presentation, major cardiac complications and outcome in a tertiarycare university hospital in Berlin, Germany. Methods and results In a single-centre cross-sectional observational study, we included 355 patients with AMI containing ST-elevation or non-ST-elevation myocardial infarction (STEMI or NSTEMI), admitted for emergency cardiac catheterization between January and April 2020 and the equivalent time in 2019. During the early phase of the Covid-19 pandemic (e-COV) in Berlin (March and April 2020), admissions for AMI halved compared with those in the pre-Covid-19 time (January and February 2020; pre-COV) and with those in the corresponding months in 2019. However, mortality for AMI increased substantially from 5.2% pre-COV to 17.7% (P < 0.05) during e-COV. Severity of presentation for AMI was more pronounced during e-COV [increased levels of cardiac enzymes, reduced left ventricular ejection fraction (LVEF), an increase in the need of inotropic support by 25% (P < 0.01)], while patients' demographic and angiographic characteristics did not differ between pre-COV and e-COV. Time from symptom onset to first medical contact was prolonged in all AMI during e-COV (presentation > 72 h +21% in STEMI, p = 0.04 and presentation > 72 h in NSTEMI +22%, p = 0.02). Door to balloon time was similar in STEMI patients, while time from first medical contact to revascularization was significantly delayed in NSTEMI patients (p = 0.02). Major cardiac complications after AMI occurred significantly more often, and cardiac recovery was worse in e-COV than in pre-COV, demonstrated by a significantly lower LVEF (39 ± 16 vs. 46 ± 16, p < 0.05) at hospital discharge and substantially higher NTproBNP levels. Conclusions The Covid-19 outbreak affects hospital admissions for acute coronary syndromes. During the first phase of the pandemia, significantly less patients with AMI were admitted, but those admitted presented with a more severe phenotype and had a higher mortality, more complications, and a worse short-term outcome. Therefore, our data indicate that Covid-19 had relevant impact on non-infectious disease states, such as acute coronary syndromes.

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Section: Discussionmentioning

confidence: 74%

Increased mortality and worse cardiac outcome of acute myocardial infarction during the early COVID‐19 pandemic

2020

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“…Intersocietal guidelines and consensus statements were created on cardiac manifestation and management of COVID-19, and protocols for performing cardiopulmonary resuscitation, coronary angiography, electrophysiology procedures and cardiac imaging during the health crisis. [12][13][14][15] While still published by traditional journals and highlighted by webinars, the power of SoMe was harnessed to facilitate rapid dissemination of these guidelines by hashtags, tweetorials, WhatsApp groups and Instagram feeds. Through SoMe, individual minds and experiences convalesced together into a unified and formidable knowledge bank at an unprecedented pace.…”

Section: Educationmentioning

confidence: 99%

Social media in the era of COVID-19

2020

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“…• The presence of myocardial injury is an independent risk factor associated with increased mortality in COVID patients. [5][6][7][8] 3) Rupture of atherosclerotic plaque on a preexisting critical/noncritical coronary artery disease, causing acute myocardial infarction (MI), usually ST elevated myocardial infarction (STEMI). • The management of patients with MI could either be using thrombolytic therapy (provided no C/I exist) or be directly referred to a percutaneous coronary intervention (PCI) center.…”

Section: Cardiac Involvement Due To Coronavirus Infection Can Occur Imentioning

confidence: 99%

“…However, the advantage of PCI approach avoids unnecessary delays arising from changes in the appearance of classical findings of ECG in STEMI. [5][6][7][8] 4) Myocardial ischemia precipitated by myocardial supply/demand mismatch due to tachycardia, hypoxia, pyrexia, and systemic inflammation which could lead to severe left ventricle (LV) dysfunction. 9,10 5) Cardiac arrhythmias varying from benign atrial/ventricular ectopics to life-threatening ventricular arrhythmias like Torsades de pointes, which could occur as a result of the following: Myocardial inflammation; use of cardiotoxic medications like chloroquine, hydroxychloroquine, azithromycin antiviral drugs; congenital disorders such as Brugada syndrome and long QT; electrolyte imbalance 11,12 (►Table 2).…”

Section: Cardiac Involvement Due To Coronavirus Infection Can Occur Imentioning

confidence: 99%

Cardiac Echocardiography in COVID-19 Infection

Garg²,

Kapur

et al. 2020

Journal of Cardiac Critical Care TSS

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The novel COVID-19 disease mainly affects respiratory organs; however, involvement of cardiovascular system is also not uncommon. Cardiac involvement can manifest as myocarditis, heart failure, myocardial infarction, pulmonary embolism, or arrhythmias in COVID-19 patients. This novel Coronavirus enters into the cells of the human body by binding to ACE-2 receptors which are predominantly present on pneumocytes and cardiomyocytes. The damage to myocardium is manifested by the increase in cardiac enzymes such as troponin-I, CK-MB, and NT pro-BNP. Although echocardiogram is an important tool in the cardiac evaluation of COVID-19 patients, its indiscriminate use is discouraged, owing to the risk of transmission to echocardiography service providers, as well as possible risk of contaminating echocardiography equipment. In this article, we discuss the different mechanisms and cardiac manifestations of COVID-19. We also review the current guidelines for echocardiography evaluation of COVID-19 patients as well as current recommendations on safety of echocardiography personnel and equipment against contamination. We also include our experience of two cases in which COVID-19 affliction of heart was strongly suspected, and echocardiography clinched the diagnosis.

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Management of acute myocardial infarction during the COVID‐19 pandemic

Abstract: The worldwide pandemic caused by the novel acute respiratory syndrome coronavi-

Cited by 137 publications

References 26 publications

Increased mortality and worse cardiac outcome of acute myocardial infarction during the early COVID‐19 pandemic

Increased mortality and worse cardiac outcome of acute myocardial infarction during the early COVID‐19 pandemic

Social media in the era of COVID-19

Cardiac Echocardiography in COVID-19 Infection

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