ACC, SCAI, ACEP Release Consensus Statement on Management of AMI Patients During COVID-19

A consensus statement from ACC, Society for Cardiovascular Angiography and Interventions (SCAI), and American College of Emergency Physicians (ACEP) outlines recommendations for a systematic approach for the care of patients with acute myocardial infarction (AMI) during the COVID-19 pandemic.

During the COVID-19 pandemic, PCI remains the standard of care for STEMI patients at PCI-capable hospitals when it can be provided in a timely fashion, with an expert care team outfitted with personal protection equipment (PPE) and in a dedicated cardiac catheterization laboratory, according to the statement published April 20 in the Journal of the American College of Cardiology.

Ehtisham Mahmud, MD, FACC, et al., recognize two major challenges in providing recommendations for AMI care during the COVID-19 pandemic. The first challenge is that "[cardiovascular] manifestations of COVID-19 are complex with patients presenting with AMI, myocarditis simulating a ST-elevation MI presentation, stress cardiomyopathy, non-ischemic cardiomyopathy, coronary spasm, or nonspecific myocardial injury." The second challenge is that the prevalence of the COVID-19 disease in the U.S. population remains unknown and there is the risk of asymptomatic spread.

With the challenges taken into consideration, the statement recommends "[informing] the public that we can minimize exposure to the coronavirus so they can continue to call the Emergency Medical System (EMS) for acute ischemic heart disease symptoms and therefore get the appropriate level of cardiac care that their presentation warrants."

The statement also recommends targeting the use of primary PCI or fibrinolysis (at referral or non-PCI capable hospitals) in patients with STEMI, aiming to avoid reperfusion therapy for those with other causes of ST-segment elevation on the electrocardiogram, and maximizing the safety of the health care team through the appropriate masking of patients and the use of PPE.

Clinical Topics: COVID-19 Hub, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Stable Ischemic Heart Disease, Vascular Medicine, Interventions and Vascular Medicine, Chronic Angina

Keywords: ST Elevation Myocardial Infarction, ACC Advocacy, Coronavirus, COVID-19, Myocarditis, Percutaneous Coronary Intervention, severe acute respiratory syndrome coronavirus 2, Electrocardiography, Fibrinolysis, Coronavirus Infections, Myocardial Infarction

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