Reperfusion of STEMI in the COVID-19 Era
- Daniels MJ, Cohen MG, Bavry AA, Kumbhani DJ.
- Reperfusion of STEMI in the COVID-19 Era – Business as Usual? Circulation 2020;Apr 13:[Epub ahead of print].
The following are key points to remember from this perspective on how patients with ST-segment elevation myocardial infarction (STEMI) should be managed during the COVID-19 pandemic:
- The authors pose the question of whether STEMI treatment during the COVID-19 pandemic be re-examined and if the fibrinolytic first approach should be considered the primary treatment choice over primary percutaneous coronary intervention (PCI).
- Currently in US practice, 13% of all STEMI patients receive pharmacoinvasive therapy, which includes a ‘drip and ship’ approach of fibrinolytic therapy (FT) followed by transfer to a PCI center for coronary angiography and PCI within 6-24 hours.
- Given its established efficacy, authors make a case for considering FT as primary therapy during the COVID-19 pandemic for STEMI patients presenting within 3 hours of symptoms and without any high-risk clinical findings.
- FT potentially could mitigate delays in reperfusion related to increased overall time in the emergency room (establish history, sick contacts, and any additional testing to rule out COVID-19) and additional time needed for cath teams to be appropriately protected.
- Door-to-needle time may be a quicker way to reperfusion even when primary PCI capabilities exist at the hospital.
- FT may also be advantageous from the standpoint of resource utilization and protection of essential health care staff such as cath teams.
- Patients can be considered for completion of a pharmacoinvasive strategy once COVID-19 has been ruled out.
- A proposed algorithm retains emergent PCI for patients who are ‘high risk’ and those who fail reperfusion therapy.
- As with other aspects of life, continuing with business as usual for STEMI care in the COVID-19 pandemic era may need to be reconsidered and FT may provide a viable alternative option.
Keywords: Acute Coronary Syndrome, Coronary Angiography, Coronavirus, COVID-19, Delivery of Health Care, Emergency Service, Hospital, Fibrinolytic Agents, Myocardial Infarction, Myocardial Reperfusion, Percutaneous Coronary Intervention, Reperfusion, severe acute respiratory syndrome coronavirus 2, Thrombolytic Therapy
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