COVID-19 and Acute Coronary Syndromes: Current Data and Future Implications

Abstract

Coronavirus disease-2019 (COVID-19) pandemic is a global healthcare burden, characterized by high mortality and morbidity rates all over the world. During the outbreak period, the topic of acute coronary syndromes (ACS) has raised several clinical issues, due to the risks of COVID-19 induced myocardial injury and to the uncertainties about the management of these cardiologic emergency conditions, which should be organized optimizing the diagnostic and therapeutic resources and ensuring the maximum protection to healthcare personnel and hospital environment. COVID-19 status should be assessed as soon as possible. Moreover, considerably lower rates of hospitalization for ACS have been reported all over the world, due to patients' hesitations to refer to hospital and to missed diagnosis. As a result, short- and long-term complications of myocardial infarction are expected in the near future; therefore, great efforts of healthcare providers will be required to limit the effects of this issue. In the present review we discuss the impact of COVID-19 pandemic on ACS diagnosis and management, with possible incoming consequences, providing an overview of the available evidence and suggesting future changes in social and clinical approach to ACS.

Keywords: COVID-19; NSTEMI; SARS-CoV2; STEMI; acute coronary syndromes; myocardial injury.

Figure 1

Algorithm for the diagnosis of COVID-induced acute myocardial injury optimizing the available imaging techniques. *hs-cTn>99th percentile of its upper normal limit, or >5 times the upper normal limit in COVID patients. ACS, acute coronary syndromes; AKI, acute kidney injury; BNP, brain natriuretic peptide; CMR, cardiac magnetic resonance; CT, cardiac tomography; DE, delayed enhancement; HF, heart failure; ICA, invasive coronary angiography; PCI, percutaneous coronary intervention.

Figure 2

Possible complications deriving from late or untreated acute coronary syndromes during COVID-19 pandemic and figurative hints for limiting them. ACS; acute coronary syndromes; HF, heart failure; ICU, intensive care unit; IV, intraventricular; LV, left ventricular; MCS, mechanical circulatory support; NSTEMI, non-ST elevation myocardial infarction; PE, pulmonary embolism; PH, pulmonary hypertension; PPE, personal protective equipment; RV, right ventricular; SCD, sudden cardiac death; STEMI, ST elevation myocardial infarction; VHD, valvular heart disease; VSD, ventricular septum defect; WMA, wall motion abnormalities.