Acute Coronary Syndromes and Covid-19: Exploring the Uncertainties

Abstract

Since an association between myocardial infarction (MI) and respiratory infections has been described for influenza viruses and other respiratory viral agents, understanding possible physiopathological links between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and acute coronary syndromes (ACS) is of the greatest importance. The initial data suggest an underestimation of ACS cases all over the world, but acute MI still represents a major cause of morbidity and mortality worldwide and should not be overshadowed during the coronavirus disease (Covid-19) pandemic. No common consensus regarding the most adequate healthcare management policy for ACS is currently available. Indeed, important differences have been reported between the measures employed to treat ACS in China during the first disease outbreak and what currently represents clinical practice across Europe and the USA. This review aims to discuss the pathophysiological links between MI, respiratory infections, and Covid-19; epidemiological data related to ACS at the time of the Covid-19 pandemic; and learnings that have emerged so far from several catheterization labs and coronary care units all over the world, in order to shed some light on the current strategies for optimal management of ACS patients with confirmed or suspected SARS-CoV-2 infection.

Keywords: Covid-19; STEMI; acute coronary syndromes; drug treatment; infectious disease; myocardial infarction; pathophysiology; percutaneous coronary intervention; respiratory infections; thrombolysis.

Figure 1

“Covid-19 related delays” in treating ST-elevation myocardial infarction (STEMI) patients. Adapted from Ibanez et al., 2017 European Society of Cardiology Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation [70]. Abbreviations: Covid-19: coronavirus disease; EMS: emergency medical services; FMC: first medical contact; PCI: percutaneous coronary intervention; STEMI: ST-elevation myocardial infarction.