Controversy in Managing Acute MI in the COVID-19 Era

Authors:
Jing ZC, Zhu HD, Yan XW, et al., on behalf of the COVID-19 & AMI Committee of Peking Union Medical College Hospital.
Citation:
Recommendations From the Peking Union Medical College Hospital for the Management of Acute Myocardial Infarction During the COVID-19 Outbreak. Eur Heart J 2020;Mar 31:[Epub ahead of print].

The following are key points to remember from this article on recommendations for the management of acute myocardial infarction (AMI) during the COVID-19 outbreak:

  1. For AMI patients with COVID-19, a safe and efficient medical environment should be ensured in parallel with effective reperfusion therapy.
  2. Many medical centers do not have professionally protected cardiac catheterization rooms and cardiac care units for respiratory infectious diseases.
  3. Under these circumstances, the prevention of COVID-19 needs the coordination of hospital administrators and the collaboration of multidisciplinary teams including the cardiology department, emergency department, infections department, respiratory department, radiology department, and the medical laboratory department. Altogether, this ensures a smooth workflow.
  4. Emergency intravenous thrombolysis is the first choice for acute ST-segment elevation myocardial infarction (STEMI).
  5. For STEMI patients with confirmed COVID-19, strict isolation should start immediately, and thrombolytic contraindications should be evaluated. Patients with thrombolytic contraindications should be transferred to the local designated infectious medical institution immediately for further treatment through the first-aid transport mode designated by the government. Patients without thrombolytic contraindications should first start intravenous thrombolysis and then transfer to the local designated medical institution of infectious disease for further treatment.
  6. If COVID-19 could be excluded by the expert group within ≤1 hour, and the possibility of having COVID-19 was clinically small, cardiologists should evaluate the following two schemes:
    • Monitor closely; conduct emergency coronary intervention immediately after elimination of COVID-19.
    • Proceed with onsite thrombolysis, make the treatment decision after comprehensive consideration of the benefit to risk ratio. During thrombolysis, review electrocardiogram, bedside echocardiography, and chest radiography. After thrombolysis, check the recanalization status of myocardial perfusion and perform chest computed tomography (CT) immediately.
  7. For AMI with non-STEMI (NSTEMI), treatment strategy should be based on the GRACE risk stratification while waiting for the results of novel coronavirus nucleic acid detection.
  8. Confirmed patients with COVID-19 should be transferred to the designated medical institution immediately for further optimal medical treatment.
  9. If COVID-19 cannot be excluded by chest CT, routine medical treatment of NSTEMI should be given and risk stratification should be conducted while waiting for the results of nucleic acid detection.
  10. For NSTEMI patients excluded from COVID-19, early or time-limited intervention strategies should be selected immediately according to the risk stratification of NSTE–acute coronary syndrome.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Cardiac Surgery and Arrhythmias, Interventions and ACS, Interventions and Imaging, Computed Tomography, Echocardiography/Ultrasound, Nuclear Imaging

Keywords: Acute Coronary Syndrome, Cardiology Interventions, Cardiac Catheterization, Coronavirus, Coronavirus Infections, COVID-19, Echocardiography, Electrocardiography, Mechanical Thrombolysis, Myocardial Infarction, Primary Prevention, Radiography, Reperfusion, Risk Assessment, Severe Acute Respiratory Syndrome, Tomography, X-Ray Computed


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