Management of Acute Myocardial Infarction During the COVID-19 Pandemic
Identifieur interne : 000930 ( Pmc/Curation ); précédent : 000929; suivant : 000931Management of Acute Myocardial Infarction During the COVID-19 Pandemic
Auteurs : Ehtisham Mahmud ; Harold L. Dauerman ; Frederick Gp. Welt ; John C. Messenger ; Sunil V. Rao ; Cindy Grines ; Amal Mattu ; Ajay J. Kirtane ; Rajiv Jauhar ; Perwaiz Meraj ; Ivan C. Rokos ; John S. Rumsfeld ; Timothy D. HenrySource :
- Journal of the American College of Cardiology [ 0735-1097 ] ; 2020.
Abstract
The worldwide pandemic caused by the novel acute respiratory syndrome coronavirus 2 (SARS-CoV2) has resulted in a new and lethal disease termed coronavirus disease 2019 (COVID-19). Although there is an association between cardiovascular disease and COVID-19, the majority of patients who need cardiovascular care for the management of ischemic heart disease may not be infected with COVID-19. The objective of this document is to provide recommendations for a systematic approach for the care of patients with an acute myocardial infarction (AMI) during the COVID-19 pandemic. There is a recognition of two major challenges in providing recommendations for AMI care in the COVID-19 era. 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 and the prevalence of COVID-19 disease in the US population remains unknown with risk of asymptomatic spread. This document addresses the care of these patients focusing on 1) the varied clinical presentations; 2) appropriate personal protection equipment (PPE) for health care workers; 3) role of the Emergency Department, Emergency Medical System and the Cardiac Catheterization Laboratory; and 4) Regional STEMI systems of care. During the COVID-19 pandemic, primary 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 team outfitted with PPE in a dedicated CCL room. A fibrinolysis-based strategy may be entertained at non-PCI capable referral hospitals or in specific situations where primary PCI cannot be executed or is not deemed the best option.
Url:
DOI: 10.1016/j.jacc.2020.04.039
PubMed: 32330544
PubMed Central: 7173829
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Ehtisham Mahmud<affiliation><nlm:aff id="aff1">University of California, San Diego, Sulpizio Cardiovascular Center, La Jolla CA</nlm:aff>
<wicri:noCountry code="subfield">La Jolla CA</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="aff2">University of Vermont, Burlington VT</nlm:aff>
<wicri:noCountry code="subfield">Burlington VT</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="aff3">University of Utah Medical Center, Salt Lake City UT</nlm:aff>
<wicri:noCountry code="subfield">Salt Lake City UT</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="aff4">University of Colorado School of Medicine, Aurora CO</nlm:aff>
<wicri:noCountry code="subfield">Aurora CO</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="aff5">Duke University Hospital, Durham NC</nlm:aff>
<wicri:noCountry code="subfield">Durham NC</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="aff6">Northside Cardiovascular Institute, Atlanta GA</nlm:aff>
<wicri:noCountry code="subfield">Atlanta GA</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="aff7">University of Maryland School of Medicine, Baltimore MD</nlm:aff>
<wicri:noCountry code="subfield">Baltimore MD</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="aff8">Columbia University Medical Center, Center for Interventional Vascular Therapy, New York NY</nlm:aff>
<wicri:noCountry code="subfield">New York NY</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="aff9">Northwell Health, Manhasset NY</nlm:aff>
<wicri:noCountry code="subfield">Manhasset NY</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="aff10">Hofstra North Shore – LIJ School of Medicine, Manhasset NY</nlm:aff>
<wicri:noCountry code="subfield">Manhasset NY</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="aff11">Methodist Hospital of Southern California, Arcadia CA</nlm:aff>
<wicri:noCountry code="subfield">Arcadia CA</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="aff12">University of Colorado Medical School, Denver CO</nlm:aff>
<wicri:noCountry code="subfield">Denver CO</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="aff13">The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati OH</nlm:aff>
<wicri:noCountry code="subfield">Cincinnati OH</wicri:noCountry>
</affiliation>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Management of Acute Myocardial Infarction During the COVID-19 Pandemic</title>
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<author><name sortKey="Dauerman, Harold L" sort="Dauerman, Harold L" uniqKey="Dauerman H" first="Harold L." last="Dauerman">Harold L. Dauerman</name>
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<wicri:noCountry code="subfield">Burlington VT</wicri:noCountry>
</affiliation>
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<author><name sortKey="Welt, Frederick Gp" sort="Welt, Frederick Gp" uniqKey="Welt F" first="Frederick Gp." last="Welt">Frederick Gp. Welt</name>
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<wicri:noCountry code="subfield">Aurora CO</wicri:noCountry>
</affiliation>
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<author><name sortKey="Rao, Sunil V" sort="Rao, Sunil V" uniqKey="Rao S" first="Sunil V." last="Rao">Sunil V. Rao</name>
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<wicri:noCountry code="subfield">Durham NC</wicri:noCountry>
</affiliation>
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<wicri:noCountry code="subfield">Atlanta GA</wicri:noCountry>
</affiliation>
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<wicri:noCountry code="subfield">Baltimore MD</wicri:noCountry>
</affiliation>
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<author><name sortKey="Kirtane, Ajay J" sort="Kirtane, Ajay J" uniqKey="Kirtane A" first="Ajay J." last="Kirtane">Ajay J. Kirtane</name>
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<wicri:noCountry code="subfield">New York NY</wicri:noCountry>
</affiliation>
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<wicri:noCountry code="subfield">Manhasset NY</wicri:noCountry>
</affiliation>
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<author><name sortKey="Rokos, Ivan C" sort="Rokos, Ivan C" uniqKey="Rokos I" first="Ivan C." last="Rokos">Ivan C. Rokos</name>
<affiliation><nlm:aff id="aff11">Methodist Hospital of Southern California, Arcadia CA</nlm:aff>
<wicri:noCountry code="subfield">Arcadia CA</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Rumsfeld, John S" sort="Rumsfeld, John S" uniqKey="Rumsfeld J" first="John S." last="Rumsfeld">John S. Rumsfeld</name>
<affiliation><nlm:aff id="aff12">University of Colorado Medical School, Denver CO</nlm:aff>
<wicri:noCountry code="subfield">Denver CO</wicri:noCountry>
</affiliation>
</author>
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<wicri:noCountry code="subfield">Cincinnati OH</wicri:noCountry>
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<front><div type="abstract" xml:lang="en"><p>The worldwide pandemic caused by the novel acute respiratory syndrome coronavirus 2 (SARS-CoV2) has resulted in a new and lethal disease termed coronavirus disease 2019 (COVID-19). Although there is an association between cardiovascular disease and COVID-19, the majority of patients who need cardiovascular care for the management of ischemic heart disease may not be infected with COVID-19. The objective of this document is to provide recommendations for a systematic approach for the care of patients with an acute myocardial infarction (AMI) during the COVID-19 pandemic. There is a recognition of two major challenges in providing recommendations for AMI care in the COVID-19 era. 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 and the prevalence of COVID-19 disease in the US population remains unknown with risk of asymptomatic spread. This document addresses the care of these patients focusing on 1) the varied clinical presentations; 2) appropriate personal protection equipment (PPE) for health care workers; 3) role of the Emergency Department, Emergency Medical System and the Cardiac Catheterization Laboratory; and 4) Regional STEMI systems of care. During the COVID-19 pandemic, primary 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 team outfitted with PPE in a dedicated CCL room. A fibrinolysis-based strategy may be entertained at non-PCI capable referral hospitals or in specific situations where primary PCI cannot be executed or is not deemed the best option.</p>
</div>
</front>
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<pmc article-type="review-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Am Coll Cardiol</journal-id>
<journal-id journal-id-type="iso-abbrev">J. Am. Coll. Cardiol</journal-id>
<journal-title-group><journal-title>Journal of the American College of Cardiology</journal-title>
</journal-title-group>
<issn pub-type="ppub">0735-1097</issn>
<issn pub-type="epub">1558-3597</issn>
<publisher><publisher-name>by the American College of Cardiology Foundation.</publisher-name>
</publisher>
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<article-id pub-id-type="pmc">7173829</article-id>
<article-id pub-id-type="publisher-id">S0735-1097(20)35026-9</article-id>
<article-id pub-id-type="doi">10.1016/j.jacc.2020.04.039</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Management of Acute Myocardial Infarction During the COVID-19 Pandemic</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" id="au1"><name><surname>Mahmud</surname>
<given-names>Ehtisham</given-names>
</name>
<degrees>MD FACC FSCAI</degrees>
<email>emahmud@health.ucsd.edu</email>
<xref rid="aff1" ref-type="aff">1</xref>
<xref rid="cor1" ref-type="corresp">ˆ</xref>
<xref rid="fn3" ref-type="fn">∗</xref>
</contrib>
<contrib contrib-type="author" id="au2"><name><surname>Dauerman</surname>
<given-names>Harold L.</given-names>
</name>
<degrees>MD FACC FSCAI</degrees>
<xref rid="aff2" ref-type="aff">2</xref>
</contrib>
<contrib contrib-type="author" id="au3"><name><surname>Welt</surname>
<given-names>Frederick GP.</given-names>
</name>
<degrees>MD FACC FSCAI</degrees>
<xref rid="aff3" ref-type="aff">3</xref>
<xref rid="fn1" ref-type="fn">§</xref>
</contrib>
<contrib contrib-type="author" id="au4"><name><surname>Messenger</surname>
<given-names>John C.</given-names>
</name>
<degrees>MD FACC FSCAI</degrees>
<xref rid="aff4" ref-type="aff">4</xref>
<xref rid="fn3" ref-type="fn">∗</xref>
</contrib>
<contrib contrib-type="author" id="au5"><name><surname>Rao</surname>
<given-names>Sunil V.</given-names>
</name>
<degrees>MD FACC FSCAI</degrees>
<xref rid="aff5" ref-type="aff">5</xref>
<xref rid="fn3" ref-type="fn">∗</xref>
</contrib>
<contrib contrib-type="author" id="au6"><name><surname>Grines</surname>
<given-names>Cindy</given-names>
</name>
<degrees>MD FACC MSCAI</degrees>
<xref rid="aff6" ref-type="aff">6</xref>
<xref rid="fn3" ref-type="fn">∗</xref>
</contrib>
<contrib contrib-type="author" id="au7"><name><surname>Mattu</surname>
<given-names>Amal</given-names>
</name>
<degrees>MD FACEP</degrees>
<xref rid="aff7" ref-type="aff">7</xref>
<xref rid="fn2" ref-type="fn">‡</xref>
</contrib>
<contrib contrib-type="author" id="au8"><name><surname>Kirtane</surname>
<given-names>Ajay J.</given-names>
</name>
<degrees>MD SM FACC FSCAI</degrees>
<xref rid="aff8" ref-type="aff">8</xref>
<xref rid="fn1" ref-type="fn">§</xref>
</contrib>
<contrib contrib-type="author" id="au9"><name><surname>Jauhar</surname>
<given-names>Rajiv</given-names>
</name>
<degrees>MD FACC FSCAI</degrees>
<xref rid="aff9" ref-type="aff">9</xref>
</contrib>
<contrib contrib-type="author" id="au10"><name><surname>Meraj</surname>
<given-names>Perwaiz</given-names>
</name>
<degrees>MD FACC FSCAI</degrees>
<xref rid="aff10" ref-type="aff">10</xref>
</contrib>
<contrib contrib-type="author" id="au11"><name><surname>Rokos</surname>
<given-names>Ivan C.</given-names>
</name>
<degrees>MD FACEP</degrees>
<xref rid="aff11" ref-type="aff">11</xref>
</contrib>
<contrib contrib-type="author" id="au12"><name><surname>Rumsfeld</surname>
<given-names>John S.</given-names>
</name>
<degrees>MD PhD FACC</degrees>
<xref rid="aff12" ref-type="aff">12</xref>
<xref rid="fn1" ref-type="fn">§</xref>
</contrib>
<contrib contrib-type="author" id="au13"><name><surname>Henry</surname>
<given-names>Timothy D.</given-names>
</name>
<degrees>MD FACC MSCAI</degrees>
<xref rid="aff13" ref-type="aff">13</xref>
<xref rid="fn3" ref-type="fn">∗</xref>
<xref rid="fn1" ref-type="fn">§</xref>
</contrib>
<aff id="aff1"><label>1</label>
University of California, San Diego, Sulpizio Cardiovascular Center, La Jolla CA</aff>
<aff id="aff2"><label>2</label>
University of Vermont, Burlington VT</aff>
<aff id="aff3"><label>3</label>
University of Utah Medical Center, Salt Lake City UT</aff>
<aff id="aff4"><label>4</label>
University of Colorado School of Medicine, Aurora CO</aff>
<aff id="aff5"><label>5</label>
Duke University Hospital, Durham NC</aff>
<aff id="aff6"><label>6</label>
Northside Cardiovascular Institute, Atlanta GA</aff>
<aff id="aff7"><label>7</label>
University of Maryland School of Medicine, Baltimore MD</aff>
<aff id="aff8"><label>8</label>
Columbia University Medical Center, Center for Interventional Vascular Therapy, New York NY</aff>
<aff id="aff9"><label>9</label>
Northwell Health, Manhasset NY</aff>
<aff id="aff10"><label>10</label>
Hofstra North Shore – LIJ School of Medicine, Manhasset NY</aff>
<aff id="aff11"><label>11</label>
Methodist Hospital of Southern California, Arcadia CA</aff>
<aff id="aff12"><label>12</label>
University of Colorado Medical School, Denver CO</aff>
<aff id="aff13"><label>13</label>
The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati OH</aff>
</contrib-group>
<author-notes><corresp id="cor1"><label>ˆ</label>
Address for Correspondence: Ehtisham Mahmud, MD, FACC, FSCAI Professor and Division Chief, Cardiovascular Medicine University of California, San Diego 9434 Medical Center Drive, La Jolla, CA 92037 Ph: (858) 657-8030 <email>emahmud@health.ucsd.edu</email>
</corresp>
<fn id="fn1"><label>§</label>
<p id="ntpara0040">Representative of the American College of Cardiology</p>
</fn>
<fn id="fn2"><label>‡</label>
<p id="ntpara0045">Representative of the American College of Emergency Physicians</p>
</fn>
<fn id="fn3"><label>∗</label>
<p id="ntpara0050">Representative of the Society of Cardiovascular Angiography & Interventions</p>
</fn>
</author-notes>
<pub-date pub-type="pmc-release"><day>21</day>
<month>4</month>
<year>2020</year>
</pub-date>
<pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="epub"><day>21</day>
<month>4</month>
<year>2020</year>
</pub-date>
<permissions><copyright-statement>© 2020 by the American College of Cardiology Foundation.</copyright-statement>
<copyright-year>2020</copyright-year>
<copyright-holder>American College of Cardiology Foundation</copyright-holder>
<license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p>
</license>
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<abstract id="abs0010"><p>The worldwide pandemic caused by the novel acute respiratory syndrome coronavirus 2 (SARS-CoV2) has resulted in a new and lethal disease termed coronavirus disease 2019 (COVID-19). Although there is an association between cardiovascular disease and COVID-19, the majority of patients who need cardiovascular care for the management of ischemic heart disease may not be infected with COVID-19. The objective of this document is to provide recommendations for a systematic approach for the care of patients with an acute myocardial infarction (AMI) during the COVID-19 pandemic. There is a recognition of two major challenges in providing recommendations for AMI care in the COVID-19 era. 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 and the prevalence of COVID-19 disease in the US population remains unknown with risk of asymptomatic spread. This document addresses the care of these patients focusing on 1) the varied clinical presentations; 2) appropriate personal protection equipment (PPE) for health care workers; 3) role of the Emergency Department, Emergency Medical System and the Cardiac Catheterization Laboratory; and 4) Regional STEMI systems of care. During the COVID-19 pandemic, primary 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 team outfitted with PPE in a dedicated CCL room. A fibrinolysis-based strategy may be entertained at non-PCI capable referral hospitals or in specific situations where primary PCI cannot be executed or is not deemed the best option.</p>
</abstract>
<kwd-group id="kwrds0010"><title>Key words</title>
<kwd>acute myocardial infarction</kwd>
<kwd>emergency medical system</kwd>
<kwd>COVID-19</kwd>
<kwd>fibrinolysis</kwd>
<kwd>percutaneous coronary intervention</kwd>
<kwd>STEMI</kwd>
</kwd-group>
<kwd-group id="kwrds0015"><title>Abbreviations</title>
<kwd>AMI, acute myocardial infarction</kwd>
<kwd>CCL, cardiac catheterization laboratory</kwd>
<kwd>COVID-19, coronavirus disease 2019</kwd>
<kwd>CT, computed tomography</kwd>
<kwd>D2B, door-to-balloon</kwd>
<kwd>ECG, electrocardiogram</kwd>
<kwd>ED, emergency department</kwd>
<kwd>EMS, emergency medical system</kwd>
<kwd>ICU, intensive care unit</kwd>
<kwd>NSTEMI, non ST-elevation myocardial infarction</kwd>
<kwd>OHCA, out-of-hospital cardiac arrest</kwd>
<kwd>PCI, percutaneous coronary intervention</kwd>
<kwd>PPE, personal protective equipment</kwd>
<kwd>STEMI, ST-elevation myocardial infarction</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
</record>
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