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5.
J Intern Med ; 290(1): 88-100, 2021 07.
Article in English | MEDLINE | ID: covidwho-1035336

ABSTRACT

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-2
8.
Rinsho Shinkeigaku ; 60(12): 822-839, 2020 Dec 26.
Article in Japanese | MEDLINE | ID: covidwho-940637

ABSTRACT

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/complications
9.
ESC Heart Fail ; 8(1): 380-389, 2021 02.
Article in English | MEDLINE | ID: covidwho-932428

ABSTRACT

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/mortality
10.
J Cardiovasc Med (Hagerstown) ; 21(12): 975-979, 2020 12.
Article in English | MEDLINE | ID: covidwho-914382

ABSTRACT

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 65 ±â€Š12 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 11 ±â€Š11 min; time spent to transport nasopharyngeal swab to the laboratory was 29 ±â€Š20 min; time to detect viral nucleic acid was 68 ±â€Š16 min. The overall time from the execution of nasopharyngeal swab to the result was 109 ±â€Š26 min. 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 0-1.5 h 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/virology
11.
Am J Cardiol ; 131: 115-119, 2020 09 15.
Article in English | MEDLINE | ID: covidwho-690300

ABSTRACT

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-2
13.
Circ Heart Fail ; 13(7): e007220, 2020 07.
Article in English | MEDLINE | ID: covidwho-546317

ABSTRACT

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.


Subject(s)
Acute Coronary Syndrome/therapy , Arrhythmias, Cardiac/therapy , Coronavirus Infections/therapy , Heart Failure/therapy , Myocarditis/therapy , Pneumonia, Viral/therapy , Acute Coronary Syndrome/complications , Anti-Bacterial Agents/adverse effects , Antiviral Agents/therapeutic use , Arrhythmias, Cardiac/chemically induced , Arrhythmias, Cardiac/complications , Azithromycin/adverse effects , Betacoronavirus , COVID-19 , Cardiotonic Agents/therapeutic use , Chronic Disease , Coronavirus Infections/complications , Cytokine Release Syndrome/complications , Cytokine Release Syndrome/therapy , Enzyme Inhibitors/adverse effects , Extracorporeal Membrane Oxygenation , Heart Failure/etiology , Heart-Assist Devices , Humans , Hydroxychloroquine/adverse effects , Intra-Aortic Balloon Pumping , Myocardial Infarction/complications , Myocardial Infarction/therapy , Myocarditis/complications , Pandemics , Percutaneous Coronary Intervention , Pneumonia, Viral/complications , SARS-CoV-2 , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy , Thromboembolism
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