Subject(s)
Chloroquine/adverse effects , Coronavirus Infections/drug therapy , Hydroxychloroquine/adverse effects , Long QT Syndrome/prevention & control , Pneumonia, Viral/drug therapy , Antiviral Agents/adverse effects , Arrhythmias, Cardiac/chemically induced , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/physiopathology , Arrhythmias, Cardiac/prevention & control , Azithromycin/adverse effects , COVID-19 , Cardiotoxicity/diagnosis , Cardiotoxicity/etiology , Cardiotoxicity/physiopathology , Cardiotoxicity/prevention & control , Coronavirus Infections/complications , Dehydration/complications , Drug Interactions , Electrocardiography , Humans , Long QT Syndrome/chemically induced , Long QT Syndrome/diagnosis , Long QT Syndrome/physiopathology , Pandemics , Pneumonia, Viral/complications , Risk Assessment , Water-Electrolyte Imbalance/complicationsABSTRACT
The diffusion of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) forced the Italian population to restrictive measures that modified patients' responses to non-SARS-CoV-2 medical conditions. We evaluated all patients with acute coronary syndromes admitted in 3 high-volume hospitals during the first month of SARS-CoV-2 Italian-outbreak and compared them with patients with ACS admitted during the same period 1 year before. Hospitalization for ACS decreased from 162 patients in 2019 to 84 patients in 2020. In 2020, both door-to-balloon and symptoms-to-percutaneous coronary intervention were longer, and admission levels of high-sensitive cardiac troponin I were higher. They had a lower discharged residual left-ventricular function and an increased predicted late cardiovascular mortality based on their Global Registry of Acute Coronary Events (GRACE) scores.
Subject(s)
Acute Coronary Syndrome/therapy , Coronavirus Infections/epidemiology , Pandemics/statistics & numerical data , Percutaneous Coronary Intervention/statistics & numerical data , Pneumonia, Viral/epidemiology , Registries , Time-to-Treatment/statistics & numerical data , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/mortality , Adult , Aged , COVID-19 , Cohort Studies , Disease Outbreaks/statistics & numerical data , Female , Hospital Mortality/trends , Hospitalization/statistics & numerical data , Hospitals, High-Volume , Humans , Italy/epidemiology , Male , Middle Aged , Percutaneous Coronary Intervention/methods , Retrospective Studies , Risk Assessment , Statistics, Nonparametric , Survival Rate , Treatment OutcomeABSTRACT
OBJECTIVE: To report our initial experience of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/acute coronary syndrome (ACS) patients undergoing standard of care invasive management. BACKGROUND: The rapid diffusion of the SARS-CoV-2 together with the need for isolation for infected patients might be responsible for a suboptimal treatment for SARS-CoV-2 ACS patients. Recently, the group of Sichuan published a protocol for COVID/ACS infected patients that see the thrombolysis as the gold standard of care. METHODS: We enrolled 31 consecutive patients affected by SARS-COV-2 admitted to our emergencies room for suspected ACS. RESULTS: All patients underwent urgent coronary angiography and percutaneous coronary intervention (PCI) when required except two patients with severe hypoxemia and unstable hemodynamic condition that were conservatively treated. Twenty-one cases presented diffuse ST-segment depression while in the remaining cases anterior and inferior ST-elevation was present in four and six cases, respectively. PCI was performed in all cases expect two that were diagnosed as suspected myocarditis because of the absence of severe coronary disease and three with apical ballooning at ventriculography diagnostic for Tako-Tsubo syndromes. Two patients conservatively treated died. The remaining patients undergoing PCI survived except one that required endotracheal intubation (ETI) and died at Day 6. ETI was required in five more patients while in the remaining cases CPAP was used for respiratory support. CONCLUSIONS: Urgent PCI for ACS is often required in SARS-CoV-2 patients improving the prognosis in all but the most advanced patients. Complete patient history and examination, routine ECG monitoring, echocardiography, and careful evaluation of changes in cardiac enzymes should be part of the regular assessment procedures also in dedicated COVID positive units.