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Management of Acute Myocardial Infarction During the COVID-19 Pandemic: A Position Statement From the Society for Cardiovascular Angiography and Interventions (SCAI), the American College of Cardiology (ACC), and the American College of Emergency Physicians (ACEP)

https://doi.org/10.1016/j.jacc.2020.04.039Get rights and content
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Abstract

The worldwide pandemic caused by the novel acute respiratory syndrome coronavirus 2 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 this novel coronavirus. 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 an ST-elevation myocardial infarction (STEMI) presentation, stress cardiomyopathy, non-ischemic cardiomyopathy, coronary spasm, or nonspecific myocardial injury, and the prevalence of COVID-19 disease in the U.S. 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.

Key Words

acute myocardial infarction
COVID-19
emergency medical system
fibrinolysis
percutaneous coronary intervention
STEMI

Abbreviations and Acronyms

AMI
acute myocardial infarction
CCL
cardiac catheterization laboratory
COVID-19
coronavirus disease 2019
CT
computed tomography
D2B
door-to-balloon
ECG
electrocardiogram
ED
emergency department
EMS
emergency medical system
ICU
intensive care unit
NSTEMI
non-ST-elevation myocardial infarction
OHCA
out-of-hospital cardiac arrest
PCI
percutaneous coronary intervention
PPE
personal protective equipment
SARS-CoV-2
severe acute respiratory syndrome-coronavirus-2
STEMI
ST-elevation myocardial infarction

Cited by (0)

This article has been co-published in Catheterization and Cardiovascular Interventions and the Journal of the American College of Cardiology.

Frederick G.P. Welt, Ajay J. Kirtane, John S. Rumsfeld and Timothy D. Henry are representatives of the American College of Cardiology. Amal Mattu is a representative of the American College of Emergency Physicians. Ehtisham Mahmud, John C. Messenger, Sunil V. Rao, Cindy Grines, and Timothy D. Henry are representatives of the Society of Cardiovascular Angiography & Interventions. This document was endorsed by the American College of Cardiology (ACC), the American College of Emergency Physicians (ACEP), and the Society for Cardiovascular Angiography & Interventions (SCAI) in April 2020.