Subacute Left Ventricular Free Wall Rupture after Delayed STEMI Presentation During the COVID-19 Pandemic

Albiero, Remo; Seresini, Giuseppe

doi:10.1016/j.jaccas.2020.06.040

Cited by 13 publications

(15 citation statements)

References 13 publications

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“…When comparing in-hospital mortality in patients admitted for cardiac catheterization there was an increase in 2020 indicating that these patients were potentially referred too late to the hospital. This finding is in line with several reports in the literature demonstrating complications after myocardial infarction more frequently due to delayed presentation [20]. It has to be concluded that the fear of contracting COVID-19, although justified, here may have resulted in an increase in non-COVID morbidity and mortality caused by avoidance of the medical system.…”

Section: Discussionsupporting

confidence: 88%

Impact of the COVID-19 pandemic on cardiovascular mortality and catherization activity during the lockdown in central Germany: an observational study

et al. 2020

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Aims During the COVID-19 pandemic, hospital admissions for cardiac care have declined. However, effects on mortality are unclear. Thus, we sought to evaluate the impact of the lockdown period in central Germany on overall and cardiovascular deaths. Simultaneously we looked at catheterization activities in the same region. Methods and results Data from 22 of 24 public health-authorities in central Germany were aggregated during the pandemic related lockdown period and compared to the same time period in 2019. Information on the total number of deaths and causes of death, including cardiovascular mortality, were collected. Additionally, we compared rates of hospitalization (n = 5178) for chronic coronary syndrome (CCS), acute coronary syndrome (ACS), and out of hospital cardiac arrest (OHCA) in 26 hospitals in this area. Data on 5,984 deaths occurring between March 23, 2020 and April 26, 2020 were evaluated. In comparison to the reference non-pandemic period in 2019 (deaths: n = 5832), there was a non-significant increase in all-cause mortality of 2.6% [incidence rate ratio (IRR) 1.03, 95% confidence interval (CI) 0.99–1.06; p = 0.16]. Cardiovascular and cardiac mortality increased significantly by 7.6% (IRR 1.08, 95%-CI 1.01–1.14; p = 0.02) and by 11.8% (IRR 1.12, 95%-CI 1.05–1.19; p < 0.001), respectively. During the same period, our data revealed a drop in cardiac catherization procedures. Conclusion During the COVID-19-related lockdown a significant increase in cardiovascular mortality was observed in central Germany, whereas catherization activities were reduced. The mechanisms underlying both of these observations should be investigated further in order to better understand the effects of a pandemic-related lockdown and social-distancing restrictions on cardiovascular care and mortality. Graphic abstract

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Section: Discussionsupporting

confidence: 88%

Impact of the COVID-19 pandemic on cardiovascular mortality and catherization activity during the lockdown in central Germany: an observational study

et al. 2020

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“…Beyond reduction in incidence, delayed presentations have been more common during the first wave, 25,26 with increases in overall symptom-to-hospital delays 24,27 along with increased out of hospital cardiac arrest rates, 11 and anecdotal evidence of increased delayed presentations and mechanical complications. [16][17][18][19][20] However, the incidence of cardiogenic shock has not increased in a large Danish registry. 28 In one Canadian study, the incidence of STEMI admission was not reduced during the pandemic period in Montreal, but unstable STEMI presentations and worse in-hospital course was more frequent, 29 data that we could not replicate with a much larger and broader sample size.…”

Section: Discussionmentioning

confidence: 99%

“…Anecdotal evidence supports increased delayed or late presentations leading to increased mechanical complications. [16][17][18][19][20] The first wave of the COVID-19 pandemic has not occurred homogeneously throughout Canada. While the province of British Columbia (BC) was affected first, Quebec and Ontario experienced the greatest infection burden during the first wave of the pandemic.…”

Section: Introductionmentioning

confidence: 99%

The COVID-19 Pandemic and Coronary Angiography for ST-Elevation Myocardial Infarction, Use of Mechanical Support, and Mechanical Complications in Canada: A Canadian Association of Interventional Cardiology National Survey

Rinfret¹,

Jahan²,

McKenzie³

et al. 2021

CJC Open

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Background As a result of the COVID-19 pandemic first wave, reductions in STEMI invasive care ranging from 23% to 76% have been reported from various countries. Whether it had any impact on coronary angiography (CA) volume or on mechanical support device use for ST-elevation myocardial infarction (STEMI) and post-STEMI mechanical complications in Canada is unknown. Methods We administered a Canada-wide survey to all Cardiac Catheterization Laboratory Directors seeking the volume of CA for STEMI performed during 01/03/2020-31/05/2020 (pandemic period) and from two control periods (01/03/2019-31/05/2019 and 01/03/2018-31/05/2018). The number of left ventricular support devices used, as well as the number of ventricular septal defects or papillary muscle rupture cases diagnosed, were also recorded. We also assessed if the number of COVID-19 cases recorded in each province was associated with STEMI CA volume. Results Forty-one out of 42 Canadian catheterization laboratories (98%) provided data. There was a modest but statistically significant 16% reduction (Incidence Rate Ratio or IRR 0.84; 95%CI 0.80-0.87) in CA for STEMI during the first wave of the pandemic compared to control periods. IRR was not associated with provincial COVID-19 caseload. We observed a 26% reduction (IRR 0.74; 95%CI 0.61-0.89) in the use of intra-aortic balloon pump in STEMI. Use of Impella® and mechanical complications from STEMI were exceedingly rare. Conclusion We observed a modest 16% decrease in CA for STEMI during the pandemic first wave in Canada, lower than reported in other countries. Provincial COVID-19 caseload did not influence this reduction.

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“…Albierto and Seresini et al. ( 18 ) present a case of delayed anterolateral STEMI resulting in a ventricular free-wall rupture that required emergent surgical repair. Moroni et al.…”

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confidence: 99%

“Back to the Future” for STEMI?

et al. 2020

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Subacute Left Ventricular Free Wall Rupture after Delayed STEMI Presentation During the COVID-19 Pandemic

Cited by 13 publications

References 13 publications

Impact of the COVID-19 pandemic on cardiovascular mortality and catherization activity during the lockdown in central Germany: an observational study

Impact of the COVID-19 pandemic on cardiovascular mortality and catherization activity during the lockdown in central Germany: an observational study

The COVID-19 Pandemic and Coronary Angiography for ST-Elevation Myocardial Infarction, Use of Mechanical Support, and Mechanical Complications in Canada: A Canadian Association of Interventional Cardiology National Survey

“Back to the Future” for STEMI?

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