Concerns for management of STEMI patients in the COVID-19 era: a paradox phenomenon

Abstract

The pandemic of coronavirus disease 2019 (COVID-19) has become a public health emergency of international concern. During this time, the management of people with acute coronary syndromes (ACS) and COVID-19 has become a global issue, especially since preexisting cardiovascular disease is a risk factor for the presence and the severity of COVID-19. The number of people with ST- elevation myocardial infarction (STEMI) has decreased during the pandemic and delays in the time looking for medical care have been reported. In addition, the diagnosis of ACS may have been difficult due to possible underlying myocarditis or other clinical entities. Regarding management of people with STEMI, although the superiority of primary percutaneous coronary intervention (PCI) over thrombolysis is well established, the notable exposure risks due to absence of negative pressure in catheterization rooms and the increased difficulty in fine manipulation on guidewires under proper protection equipment may contribute to the relatively secondary role of PCI during the COVID-19 pandemic; thus, fibrinolytic therapy or robotic-assisted PCI in early presenting STEMI patients may have an alternative role during this period if prevention measures cannot be taken. Healthcare stuff should take the proper measures to avoid the spread of and their exposure to the virus.

Keywords: Acute coronary syndrome; Acute myocardial infarction; COVID-19; Percutaneous coronary intervention; STEMI; Thrombolysis.

Fig. 1

Concerns for management of suspected STEMI patients with potential risk of COVID-19 infection. ACS, Acute Coronary Syndrome; Cath lab, catheterization laboratory; COVID-19, coronavirus disease 2019; FMC, first medical contact; PCI; percutaneous coronary intervention; PPE, proper protection equipment