ABSTRACT
The novel SARS-CoV-2 has directly and indirectly impacted patients with acute coronary syndrome (ACS). The onset of the COVID-19 pandemic correlated with an abrupt decline in hospitalizations with ACS and increased out-of-hospital deaths. Worse outcomes in ACS patients with concomitant COVID-19 have been reported, and acute myocardial injury secondary to SARS-CoV-2 infection is recognized. A rapid adaptation of existing ACS pathways has been required such that overburdened health care systems may manage both a novel contagion and existing illness. As SARS-CoV-2 is now endemic, future research is required to better define the complex interplay of COVID-19 infection and cardiovascular disease.
Subject(s)
Acute Coronary Syndrome , COVID-19 , Humans , COVID-19/epidemiology , SARS-CoV-2 , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/epidemiology , Pandemics , HospitalizationABSTRACT
Coronavirus disease 2019 (COVID-19) is a novel pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has been shown that SARS-CoV-2 infection-induced inflammatory and oxidative stress and associated endothelial dysfunction may lead to the development of acute coronary syndrome (ACS). Therefore, this review aimed to ascertain the link between severe SARS-CoV-2 infection and ACS. ACS is a spectrum of acute myocardial ischemia due to a sudden decrease in coronary blood flow, ranging from unstable angina to myocardial infarction (MI). Primary or type 1 MI (T1MI) is mainly caused by coronary plaque rupture and/or erosion with subsequent occlusive thrombosis. Secondary or type 2 MI (T2MI) is due to cardiac and systemic disorders without acute coronary atherothrombotic disruption. Acute SARS-CoV-2 infection is linked with the development of nonobstructive coronary disorders such as coronary vasospasm, dilated cardiomyopathy, myocardial fibrosis, and myocarditis. Furthermore, SARS-CoV-2 infection is associated with systemic inflammation that might affect coronary atherosclerotic plaque stability through augmentation of cardiac preload and afterload. Nevertheless, major coronary vessels with atherosclerotic plaques develop minor inflammation during COVID-19 since coronary arteries are not initially and primarily targeted by SARS-CoV-2 due to low expression of angiotensin-converting enzyme 2 in coronary vessels. In conclusion, SARS-CoV-2 infection through hypercytokinemia, direct cardiomyocyte injury, and dysregulation of the renin-angiotensin system may aggravate underlying ACS or cause new-onset T2MI. As well, arrhythmias induced by anti-COVID-19 medications could worsen underlying ACS.
Subject(s)
Acute Coronary Syndrome , COVID-19 , Myocardial Infarction , Plaque, Atherosclerotic , Humans , COVID-19/complications , Acute Coronary Syndrome/complications , SARS-CoV-2 , Myocardial Infarction/complications , Inflammation , Plaque, Atherosclerotic/complicationsABSTRACT
The novel SARS-CoV-2 has directly and indirectly impacted patients with acute coronary syndrome (ACS). The onset of the COVID-19 pandemic correlated with an abrupt decline in hospitalizations with ACS and increased out-of-hospital deaths. Worse outcomes in ACS patients with concomitant COVID-19 have been reported, and acute myocardial injury secondary to SARS-CoV-2 infection is recognized. A rapid adaptation of existing ACS pathways has been required such that overburdened health care systems may manage both a novel contagion and existing illness. As SARS-CoV-2 is now endemic, future research is required to better define the complex interplay of COVID-19 infection and cardiovascular disease.
Subject(s)
Acute Coronary Syndrome , COVID-19 , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/epidemiology , COVID-19/complications , Hospitalization , Humans , Pandemics , SARS-CoV-2ABSTRACT
BACKGROUND: There is a lack of knowledge about the real incidence of acute coronary syndrome (ACS) in patients with COVID-19, their clinical characteristics, and their prognoses. OBJECTIVE: We investigated the incidence, clinical characteristics, risk factors, and outcomes of ACS in patients with COVID-19 in the emergency department. METHODS: We retrospectively reviewed all COVID-19 patients diagnosed with ACS in 62 Spanish emergency departments between March and April 2020 (the first wave of COVID-19). We formed 2 control groups: COVID-19 patients without ACS (control A) and non-COVID-19 patients with ACS (control B). Unadjusted comparisons between cases and control subjects were performed regarding 58 characteristics and outcomes. RESULTS: We identified 110 patients with ACS in 74,814 patients with COVID-19 attending the ED (1.48% [95% confidence interval {CI} 1.21-1.78%]). This incidence was lower than that observed in non-COVID-19 patients (3.64% [95% CI 3.54-3.74%]; odds ratio [OR] 0.40 [95% CI 0.33-0.49]). The clinical characteristics of patients with COVID-19 associated with a higher risk of presenting ACS were: previous coronary artery disease, age ≥60 years, hypertension, chest pain, raised troponin, and hypoxemia. The need for hospitalization and admission to intensive care and in-hospital mortality were higher in cases than in control group A (adjusted OR [aOR] 6.36 [95% CI 1.84-22.1], aOR 4.63 [95% CI 1.88-11.4], and aOR 2.46 [95% CI 1.15-5.25]). When comparing cases with control group B, the aOR of admission to intensive care was 0.41 (95% CI 0.21-0.80), while the aOR for in-hospital mortality was 5.94 (95% CI 2.84-12.4). CONCLUSIONS: The incidence of ACS in patients with COVID-19 attending the emergency department was low, around 1.48%, but could be increased in some circumstances. Patients with COVID-19 with ACS had a worse prognosis than control subjects with higher in-hospital mortality.
Subject(s)
Acute Coronary Syndrome , COVID-19 , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/epidemiology , COVID-19/complications , COVID-19/epidemiology , Emergency Service, Hospital , Humans , Incidence , Middle Aged , Retrospective Studies , Risk FactorsSubject(s)
Acute Coronary Syndrome/therapy , Betacoronavirus , Coronavirus Infections , Infection Control/methods , Pandemics , Pneumonia, Viral , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/diagnosis , Betacoronavirus/isolation & purification , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Emergencies , Global Health , Humans , Italy/epidemiology , Myocardial Infarction/complications , Myocardial Infarction/diagnosis , Myocardial Infarction/therapy , Pandemics/prevention & control , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2Subject(s)
COVID-19/complications , COVID-19/mortality , Cardiovascular Diseases/complications , Cardiovascular Diseases/mortality , Diabetes Complications/mortality , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/epidemiology , Age Factors , Aged , Aged, 80 and over , Coronary Artery Disease/complications , Coronary Artery Disease/mortality , Diabetes Complications/epidemiology , Female , Hospital Mortality , Humans , Incidence , Male , Middle Aged , Prevalence , Regression Analysis , Risk Factors , Severity of Illness Index , Stroke/complications , Stroke/epidemiologySubject(s)
Acute Coronary Syndrome/complications , Betacoronavirus , Coronavirus Infections/complications , Emergencies , Myocardial Ischemia/complications , Pneumonia, Viral/complications , Acute Coronary Syndrome/therapy , COVID-19 , Cardiac Care Facilities , Coronavirus Infections/therapy , Humans , Myocardial Ischemia/therapy , Pandemics , Patient Care Management , Pneumonia, Viral/therapy , SARS-CoV-2ABSTRACT
BACKGROUND: Patients with underlying cardiovascular disease and coronavirus disease 2019 (COVID-19) infection are at increased risk of morbidity and mortality. OBJECTIVES: This study was designed to characterize the presenting profile and outcomes of patients hospitalized with acute coronary syndrome (ACS) and COVID-19 infection. METHODS: This observational cohort study was conducted using multisource data from all acute NHS hospitals in England. All consecutive patients hospitalized with diagnosis of ACS with or without COVID-19 infection between 1 March and 31 May 2020 were included. The primary outcome was in-hospital and 30-day mortality. RESULTS: A total of 12 958 patients were hospitalized with ACS during the study period, of which 517 (4.0%) were COVID-19-positive and were more likely to present with non-ST-elevation acute myocardial infarction. The COVID-19 ACS group were generally older, Black Asian and Minority ethnicity, more comorbid and had unfavourable presenting clinical characteristics such as elevated cardiac troponin, pulmonary oedema, cardiogenic shock and poor left ventricular systolic function compared with the non-COVID-19 ACS group. They were less likely to receive an invasive coronary angiography (67.7% vs 81.0%), percutaneous coronary intervention (PCI) (30.2% vs 53.9%) and dual antiplatelet medication (76.3% vs 88.0%). After adjusting for all the baseline differences, patients with COVID-19 ACS had higher in-hospital (adjusted odds ratio (aOR): 3.27; 95% confidence interval (CI): 2.41-4.42) and 30-day mortality (aOR: 6.53; 95% CI: 5.1-8.36) compared to patients with the non-COVID-19 ACS. CONCLUSION: COVID-19 infection was present in 4% of patients hospitalized with an ACS in England and is associated with lower rates of guideline-recommended treatment and significant mortality hazard.
Subject(s)
Acute Coronary Syndrome/complications , Acute Coronary Syndrome/mortality , COVID-19/complications , COVID-19/mortality , Aged , Electronic Health Records , England/epidemiology , Female , Guideline Adherence , Hospital Mortality , Hospitalization , Humans , Male , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , Prevalence , Risk Factors , SARS-CoV-2Subject(s)
Acute Coronary Syndrome/complications , COVID-19/complications , ST Elevation Myocardial Infarction/complications , Acute Coronary Syndrome/diagnosis , Coronary Angiography , Electrocardiography , Female , Humans , Middle Aged , Risk Factors , SARS-CoV-2 , ST Elevation Myocardial Infarction/diagnosisSubject(s)
Acute Coronary Syndrome/drug therapy , Coronavirus Infections/pathology , Platelet Aggregation Inhibitors/therapeutic use , Pneumonia, Viral/pathology , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/pathology , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/virology , Disease Progression , Hemorrhage/etiology , Humans , Lung/pathology , Pandemics , Percutaneous Coronary Intervention , Platelet Aggregation Inhibitors/adverse effects , Platelet Count , Pneumonia, Viral/complications , Pneumonia, Viral/virology , SARS-CoV-2ABSTRACT
Due to the pandemic of corona virus disease 2019 (COVID-19), the stroke medical care system is unavoidably undergoing major changes such as a decrease in the number of stroke patients receiving consultation, delay in consultation, and a decrease in the number of intravenous thrombolysis and mechanical thrombectomy procedures. Stroke incidence in COVID-19 patients is approximately 1.1%. The features of stroke with COVID-19 have been elucidated: higher incidence in ischemic stroke than hemorrhagic stroke, increasing number of young patients, high D-dimer levels, and higher risk in elderly patients with cardiovascular risk factors such as hypertension and diabetes. In patients with COVID-19, venous thromboembolism is more common than arterial thromboembolism, and stroke is more common than acute coronary syndrome. Protected code stroke (PCS) has been proposed which provides safe, effective and prompt treatment under complete infection control.
Subject(s)
COVID-19/complications , Stroke/complications , Stroke/therapy , Acute Coronary Syndrome/complications , Diabetes Mellitus , Fibrin Fibrinogen Degradation Products/analysis , Humans , Hypertension , Pandemics , Risk Factors , Thrombectomy/statistics & numerical data , Thrombolytic Therapy/statistics & numerical data , Venous Thromboembolism/complicationsABSTRACT
AIMS: Cardiovascular disease has been recognized as a major determinant of coronavirus disease 2019 (COVID-19) vulnerability and severity. Angiotensin-converting enzyme (ACE) 2 is a functional receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is up-regulated in patients with heart failure. We sought to examine the potential association between reduced left ventricular ejection fraction (LVEF) and the susceptibility to SARS-CoV-2 infection. METHODS AND RESULTS: Of the 1162 patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention between February 2014 and October 2018, we enrolled 889 patients with available clinical follow-up data. Follow-up was conducted by telephone interviews 1 month after the start of the French lockdown which began on 17 March 2020. Patients were divided into two groups according to LVEF <40% (reduced LVEF) (n = 91) or ≥40% (moderately reduced + preserved LVEF) (n = 798). The incidence of COVID-19-related hospitalization or death was significantly higher in the reduced LVEF group as compared with the moderately reduced + preserved LVEF group (9% vs. 1%, P < 0.001). No association was found between discontinuation of ACE-inhibitor or angiotensin-receptor blockers and COVID-19 test positivity. By multivariate logistic regression analysis, reduced LVEF was an independent predictor of COVID-19 hospitalization or death (odds ratio: 6.91, 95% confidence interval: 2.60 to 18.35, P < 0.001). CONCLUSIONS: In a large cohort of patients with previous ACS, reduced LVEF was associated with increased susceptibility to COVID-19. Aggressive COVID-19 testing and therapeutic strategies may be considered for patient with impaired heart function.
Subject(s)
COVID-19/etiology , Disease Susceptibility/etiology , Ventricular Dysfunction, Left/complications , Acute Coronary Syndrome/complications , Aged , COVID-19/mortality , Female , France/epidemiology , Hospitalization/statistics & numerical data , Humans , Logistic Models , Male , Middle Aged , Propensity Score , Retrospective Studies , SARS-CoV-2 , Stroke Volume , Ventricular Dysfunction, Left/mortalityABSTRACT
AIMS: Patients with acute coronary syndrome (ACS) often arrive in the catheterization (cath) lab directly from the field or an emergency department without an accurate triage for Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.Although in the pandemic period the treatment in the cath laboratory of high-risk ACS should not be delayed because the operators wear special protection systems, the subsequent risk of contagion in a non-Covid coronary care unit could be high in the case of patients positive for SARS-CoV-2. METHODS: We tested the possibility of a fast-track protocol in 51 consecutive patients (mean age 65â±â12 years) transferred from spokes centres or from the field to our HUB centre and admitted to our coronary care unit (CCU). Once the patient had arrived in the cath lab, the nasopharyngeal swab was performed. The real-time PCR to extract RNA for SARS-CoV-2 detection was performed with an automated rapid molecular Xpert Xpress test. Meanwhile, coronary angiography or percutaneous coronary intervention was performed if necessary. RESULTS: In this fast-track protocol, the time to perform nasopharyngeal swab was 11â±â11âmin; time spent to transport nasopharyngeal swab to the laboratory was 29â±â20âmin; time to detect viral nucleic acid was 68â±â16âmin. The overall time from the execution of nasopharyngeal swab to the result was 109â±â26âmin. The results were immediately put into the hospital computer system and made readily available. Depending on the test result, patients were then transferred to the regular CCU or Covid area. CONCLUSION: This study demonstrates that 0-1.5âh fast-track triage for coronavirus disease 2019 (COVID 19) is feasible in patients with ACS. The execution of nasopharyngeal swab in the cath lab and its analysis with a rapid molecular test allows rapid stratification of SARS-CoV-2 infection.
Subject(s)
Acute Coronary Syndrome/complications , COVID-19 Nucleic Acid Testing , COVID-19/diagnosis , SARS-CoV-2/isolation & purification , Aged , Automation, Laboratory , COVID-19/virology , Feasibility Studies , Female , Humans , Italy , Male , Middle Aged , Nasopharynx/virologyABSTRACT
Accumulating evidence suggests that influenza and influenza-like illnesses can act as a trigger for acute myocardial infarction. Despite these unprecedented times providers should not overlook acute coronary syndrome (ACS) guidelines, but may choose to modify the recommended approach in situations with confirmed or suspected COVID-19 disease. In this document, we suggest recommendations as to how to triage patients diagnosed with ACSs and provide with algorithms of how to manage the patients and decide the appropriate treatment options in the era of COVID-19 pandemic. We also address the inpatient logistics and discharge to follow-up considerations for the function of already established ACS network during the pandemic.
Subject(s)
Acute Coronary Syndrome/therapy , Betacoronavirus , Coronavirus Infections/complications , Disease Management , Pneumonia, Viral/complications , Triage/methods , Acute Coronary Syndrome/complications , COVID-19 , Coronavirus Infections/epidemiology , Humans , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2Subject(s)
Acute Coronary Syndrome , Coronavirus Infections , Emergency Medical Services/statistics & numerical data , Out-of-Hospital Cardiac Arrest , Pandemics , Pneumonia, Viral , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/mortality , Betacoronavirus , COVID-19 , Communicable Disease Control/methods , Coronavirus Infections/complications , Coronavirus Infections/mortality , Coronavirus Infections/prevention & control , Hospitalization/statistics & numerical data , Humans , New York City/epidemiology , Out-of-Hospital Cardiac Arrest/epidemiology , Out-of-Hospital Cardiac Arrest/etiology , Pandemics/prevention & control , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Pneumonia, Viral/prevention & control , Retrospective Studies , SARS-CoV-2ABSTRACT
The novel coronavirus disease 2019, otherwise known as COVID-19, is a global pandemic with primary respiratory manifestations in those who are symptomatic. It has spread to >187 countries with a rapidly growing number of affected patients. Underlying cardiovascular disease is associated with more severe manifestations of COVID-19 and higher rates of mortality. COVID-19 can have both primary (arrhythmias, myocardial infarction, and myocarditis) and secondary (myocardial injury/biomarker elevation and heart failure) cardiac involvement. In severe cases, profound circulatory failure can result. This review discusses the presentation and management of patients with severe cardiac complications of COVID-19 disease, with an emphasis on a Heart-Lung team approach in patient management. Furthermore, it focuses on the use of and indications for acute mechanical circulatory support in cardiogenic and/or mixed shock.