April 23, 2020

Societies publish recommendations for managing patients with acute MI amid COVID-19 pandemic

By Denise Baez

NEW YORK - April 23, 2020 - The Society for Cardiovascular Angiography and Interventions (SCAI), the American College of Cardiology (ACC), and the American College of Emergency Physicians (ACEP) have released a consensus statement that provides recommendations for a systematic approach for the care of patients with an acute myocardial infarction (AMI) during the coronavirus disease 2019 (COVID-19) pandemic.

The document is jointly published in Catheterization and Cardiovascular Interventions and the Journal of the American College of Cardiology

“Cardiovascular manifestations of COVID‐19 are complex with patients presenting with AMI, myocarditis simulating a ST‐elevation MI presentation, stress cardiomyopathy, non‐ischaemic 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,” wrote Ehtisham Mahmud, MD, University of California San Diego, San Diego, California, and colleagues. 

The 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 (EMS), and the Cardiac Catheterisation Laboratory; and (4) regional STEMI systems of care.

“During the COVID-19 pandemic we wanted to ensure that patients continue to benefit from the tremendous advances made in the care of patients with cardiovascular disease over the past three decades,” said Dr. Mahmud. “Primary percutaneous coronary intervention (PCI) is the standard of care for patients with STEMI, and in this document, we outline an approach to providing that therapy at PCI-capable hospitals while also ensuring health care worker safety with appropriate PPE.”

The writing group recommends that during the COVID‐19 pandemic, primary PCI remains the standard of care for patients with STEMI at PCI-capable hospitals when it can be provided in a timely fashion, with an expert team outfitted with PPE in a dedicated cardiac catheterisation laboratory 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. The writing group also recommends that patients continue to call EMS when presenting with acute ischaemic heart disease symptoms. 

SOURCE: Society for Cardiovascular Angiography and Interventions