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Review
. 2020 Aug;21(8):1024-1029.
doi: 10.1016/j.carrev.2020.05.027. Epub 2020 May 21.

Treatment of ST-Segment Elevation Myocardial Infarction During COVID-19 Pandemic

Charan Yerasi  1 , Brian C Case  1 , Brian J Forrestal  1 , Chava Chezar-Azerrad  1 , Hayder Hashim  1 , Itsik Ben-Dor  1 , Lowell F Satler  1 , Gary S Mintz  1 , Ron Waksman  2
Affiliations
Review

Treatment of ST-Segment Elevation Myocardial Infarction During COVID-19 Pandemic

Charan Yerasi et al. Cardiovasc Revasc Med. 2020 Aug.

Abstract

The number of cases of the coronavirus-induced disease-2019 (COVID-19) continues to increase exponentially worldwide. In this crisis situation, the management of ST-segment elevation myocardial infarction (STEMI) is challenging. In this review, we outline the risks and benefits of primary PCI vs. thrombolysis for STEMI. While thrombolysis may seem like a good choice, many patients have a contraindication and could end up using more resources. Also, with a high probability of the angiogram showing non-obstructed coronary arteries during acute infections, primary PCI should be the preferred strategy.

Keywords: COVID-19; Fibrinolytics; Primary percutaneous coronary intervention; STEMI.

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Conflict of interest statement

Declaration of competing interest Ron Waksman – Advisory Board: Amgen, Boston Scientific, Cardioset, Cardiovascular Systems Inc., Medtronic, Philips, Pi-Cardia Ltd.; Consultant: Amgen, Biotronik, Boston Scientific, Cardioset, Cardiovascular Systems Inc., Medtronic, Philips, Pi-Cardia Ltd.; Grant Support: AstraZeneca, Biotronik, Boston Scientific, Chiesi; Speakers Bureau: AstraZeneca, Chiesi; Investor: MedAlliance. Gary S. Mintz - Honoraria from Boston Scientific, Philips, Terumo, and Medtronic. All other authors – None.

Figures

Fig. 1
Fig. 1
Initial management of STEMI during COVID-19 pandemic. *In these patients, thrombolysis should be avoided. If available, cardiac magnetic resonance imaging can be done to evaluate for myocarditis. If in doubt, coronary angiogram should be performed rather than thrombolysis. STEMI - ST-segment elevation myocardial infarction.
Fig. 2
Fig. 2
Risks vs. benefits of treating STEMI with thrombolysis during COVID-19. *Myocarditis, pericarditis, takotsubo cardiomyopathy. STEMI - ST-segment elevation myocardial infarction. ACS - Acute coronary syndrome.
Fig. 3
Fig. 3
Risks vs. benefits of treating STEMI with primary percutaneous coronary intervention during COVID-19. STEMI - ST-segment elevation myocardial infarction PCI - Percutaneous coronary intervention. PPE - Personal protective equipment.
Fig. 4
Fig. 4
Six rules of “donning” and “doffing” personal protective equipment.
Fig. 5
Fig. 5
Treatment algorithm for management of STEMI during COVID-19. *COVID-19 person under investigation: Any patient with fever or cough or shortness of breath with an elevated biomarker (C-reactive protein or lactate dehydrogenase) but a negative rapid COVID-19 test. ** Rule out ACS mimics before administering thrombolysis such as myocarditis, takotsubo cardiomyopathy, or pericarditis by careful evaluation of EKG and point-of-care ultrasound. STEMI - ST-segment elevation myocardial infarction. PCI - Percutaneous coronary intervention. PUI - Patient under investigation.
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