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1.
J Investig Med ; 70(4): 892-898, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1784873

ABSTRACT

The aim of the study was to evaluate the diagnostic significance of ST-segment re-elevation episodes registered with telemetric ECG monitoring in patients with ST-segment elevation myocardial infarction (STEMI) treated with thrombolytic therapy (TLT). The study included 117 patients with STEMI following effective TLT. The elective coronary angiography followed by percutaneous coronary interventions was performed in the interval from 3 to 24 hours after a successful systemic TLT. Before and after cardiac catheterization, the telemetric ECG monitoring was performed using AstroCard Telemetry system (Meditec, Russia). During the study, two groups of patients were formed. Group 1 included 85 patients (72.6%) without new ST-segment deviations on telemetry. 77 patients (90.6%) had no recurrent coronary artery thrombosis at angiography. Eight patients (9.4%) from group 1 were diagnosed with thrombosis of the infarct-related coronary artery. Group 2 included 32 patients (27.4%) who underwent TLT and then had ST-segment re-elevation episodes of 1 mV or more in the infarct-related leads, lasting for at least 1 minute. In group 2, in 27 of 32 patients (84.4%), thrombosis of the infarct-related coronary artery was confirmed (p<0.01 compared with group 1). In 71.9% cases, the recurrent ischemic episodes were asymptomatic ('painless myocardial ischemia') (p<0.01). Thus, in patients with STEMI and successful TLT, re-elevation of ST-segment during remote ECG monitoring is strongly related to angiographically documented coronary artery thrombotic reocclusion. The absence of chest pain during recurrent myocardial ischemia requires continuous ECG telemetry to select patients for the rescue percutaneous coronary interventions at an earlier stage.


Subject(s)
Coronary Artery Disease , Myocardial Infarction , Myocardial Ischemia , ST Elevation Myocardial Infarction , Coronary Angiography , Coronary Artery Disease/etiology , Electrocardiography , Fibrinolytic Agents/therapeutic use , Humans , Myocardial Ischemia/diagnosis , Myocardial Ischemia/drug therapy , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/drug therapy , Thrombolytic Therapy/adverse effects
2.
Eur J Radiol ; 149: 110188, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1664888

ABSTRACT

SARS-CoV-2 infection, responsible for COVID-19 outbreak, can cause cardiac complications, worsening outcome and prognosis. In particular, it can exacerbate any underlying cardiovascular condition, leading to atherosclerosis and increased plaque vulnerability, which may cause acute coronary syndrome. We review current knowledge on the mechanisms by which SARS-CoV-2 can trigger endothelial/myocardial damage and cause plaque formation, instability and deterioration. The aim of this review is to evaluate current non-invasive diagnostic techniques for coronary arteries evaluation in COVID-19 patients, such as coronary CT angiography and atherosclerotic plaque imaging, and their clinical implications. We also discuss the role of artificial intelligence, deep learning and radiomics in the context of coronary imaging in COVID-19 patients.


Subject(s)
COVID-19 , Coronary Artery Disease , Plaque, Atherosclerotic , Artificial Intelligence , Coronary Angiography/methods , Coronary Artery Disease/diagnostic imaging , Coronary Vessels , Humans , Plaque, Atherosclerotic/diagnostic imaging , SARS-CoV-2
5.
Monaldi Arch Chest Dis ; 91(3)2021 04 06.
Article in English | MEDLINE | ID: covidwho-1580244

ABSTRACT

The coronary angiographic (CAG) findings of ST elevation myocardial infarction (STEMI) in patients of coronavirus disease 2019 (COVID-19) range from increased coronary artery thrombus burden to normal coronaries due to STEMI mimics. Here we report the case of a 45-year-old gentleman who presented with evolved inferior wall myocardial infarction with ongoing angina along with mild COVID-19. CAG showed normal epicardial coronaries except for distal right posterior descending coronary artery (RPDA) 100% occlusion on careful examination. He was treated for the myocardial infarction with medical management along with treatment of COVID-19. The importance of our case is to highlight the possibility of distal total occlusion of small coronary branches which may be missed if not carefully looked for as a normal CAG in COVID-19 patient will require only supportive therapy, while the finding of distal 100% occlusion of RPDA deemed us to prescribe optimal medical therapy as per acute myocardial infarction protocol along with treatment for COVID-19.


Subject(s)
COVID-19 , Myocardial Infarction , ST Elevation Myocardial Infarction , Coronary Angiography , Humans , Male , Middle Aged , Myocardial Infarction/diagnostic imaging , SARS-CoV-2 , ST Elevation Myocardial Infarction/diagnostic imaging
6.
BMJ Case Rep ; 14(12)2021 Dec 07.
Article in English | MEDLINE | ID: covidwho-1561838

ABSTRACT

Since the start of the COVID-19 pandemic, several cases have reported extensive multivessel coronary thrombosis as a cardiovascular manifestation of SARS-CoV-2 infection. This case describes a patient who developed non-ST elevation myocardial infarction during hospitalization for acute hypoxic respiratory failure due to COVID-19. We review the immediate and delayed revascularisation strategies of culprit and non-culprit lesions in the setting of high intracoronary thrombus burden induced by SARS-CoV-2. Successful percutaneous intervention and stenting of a culprit lesion and resolution of an intracoronary thrombus using a delayed strategy of lesion passivation with adjuvant pharmacotherapy are demonstrated on index and follow-up angiography.


Subject(s)
COVID-19 , Coronary Thrombosis , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Coronary Angiography , Coronary Thrombosis/diagnostic imaging , Coronary Thrombosis/therapy , Humans , Pandemics , SARS-CoV-2 , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/surgery , Treatment Outcome
7.
Ann Cardiol Angeiol (Paris) ; 70(6): 435-445, 2021 Dec.
Article in French | MEDLINE | ID: covidwho-1540362

ABSTRACT

Developed in the late 1980s, rotational atherectomy has raised a lot of hope for its innovative principle of selective ablation, allowing volume reduction (instead of redistribution) of atherosclerotic plaque, while sparing healthy tissue. Long shunned for its disappointing results on restenosis, the Rotablator finally reasserted itself in the 2000s; era of drug eluting stents and coronary angioplasty boom, thus generating emergence of complex lesions. Indeed, the Rotablator has demonstrated an undeniable benefit in complex (type C) and calcified lesions preparation (before stenting), with a procedural success rate of 95%. Although these lesions only represent a small amount (2-3%) of percutaneous coronary interventions (PCI), they remain a technical impasse for plain-old balloon angioplasty strategy, making the Rotablator more suitable for these resistant lesions' treatment. Registry data attest the safety of this therapy, with a rate of peri-procedural complications and in-hospital mortality comparable to conventional angioplasty (France PCI register). However, certain specific, rare but serious complications (burr entrapment, broken Rotawire, coronary perforation) justify trained teams, perfect knowledge of the equipment, and strict compliance with good practice guidelines. In 2018, the rise of a new method of atherectomy by intra-vascular lithotripsy (Shockwave) has coincided with Rotablator decreasing activity (this finding being biased by a general decrease in PCI activity due to Covid pandemic). This therapeutic range's enhancement revolutionizes calcified lesions treatment, tending towards precise targeting of each indication, depending in particular on calcium distribution's anatomy in the plaque.


Subject(s)
Atherectomy, Coronary , COVID-19 , Coronary Artery Disease , Percutaneous Coronary Intervention , Coronary Angiography , Coronary Artery Disease/surgery , Humans , Registries , SARS-CoV-2 , Treatment Outcome
8.
Braz J Med Biol Res ; 54(12): e11681, 2021.
Article in English | MEDLINE | ID: covidwho-1533464

ABSTRACT

Risk factors that determine the severity of Covid-19 have not been fully elucidated. The aim of this study was to evaluate the role of coronary artery calcification (CAC) as a risk factor for death or mechanical ventilation (MV) of patients without known heart disease infected with Covid-19. We analyzed 283 consecutive in-patients with acute respiratory symptoms with chest computed tomography (chest-CT), without previous heart disease, and criteria for Covid-19 (RT-PCR positive and/or typical clinical and chest-CT findings). CAC was classified by the number of coronary segments affected as absent (0), mild (1-3), and severe calcification (more than 3). The association between CAC, CAC severity, and death or MV due to severe respiratory failure was assessed by logistic regression. The mean age was 58.7±15.7 years and 54.1% were men. Patients with CAC were older, more likely to have hypertension, and less likely to be obese. CAC was present in 75 patients (26.5%), of which 42 had a mild calcification and 33 had severe calcification, and was associated with death (OR=2.35, 95%CI: 1.01-5.48) or MV (OR=2.72, 95%CI: 1.20-6.20) adjusted for multiple confounders, with significant and increased odds ratio for the severe form of CAC (death: OR=3.70, 95%CI: 1.20-11.42; MV: OR=3.30, 95%CI: 1.09-9.95). We concluded that CAC was an independent risk factor for death or MV in Covid-19 patients without previous heart disease, particularly for those with severe calcification. CAC can be easily visualized on common chest-CT, widely used in evaluation of moderate to severe Covid-19.


Subject(s)
COVID-19 , Coronary Artery Disease , Vascular Calcification , Adult , Aged , Coronary Angiography , Coronary Artery Disease/diagnostic imaging , Humans , Male , Middle Aged , Odds Ratio , Risk Factors , SARS-CoV-2 , Vascular Calcification/complications , Vascular Calcification/diagnostic imaging
9.
Int J Cardiovasc Imaging ; 38(2): 447-456, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1527480

ABSTRACT

We aimed to examine the effect of a history of COVID-19 on myocardial ischemia in single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in patients who presented with shortness of breath and/or chest pain after recovery. For this single-center retrospective study, patients who presented at cardiology outpatient clinics and had SPECT-MPI were screened. A total of 1888 patients were included in the study, 340 of whom had a history of COVID-19. 64 patients with > 50% stenosis on coronary angiography were excluded from the study. The primary outcome of the study was abnormal MPI. In the study population, the median age was 56 (49-64 IQR) years, and 1127 (65%) of the patients were female. Abnormal MPI was detected in 77 patients (23%) in the COVID-19 group and in 244 patients (16%) in the non-COVID-19 group. After adjustment was performed for clinical predictors using Bayesian logistic regression, an important association was found between the presence of a confirmed prior COVID-19 infection and abnormal MPI (posterior median odds ratio, 1.70 [95% CrI, 1.20-2.40], risk difference, 9.6% [95% CrI, 1.8%, 19.7%]). In SPECT-MPI, ischemia rates were observed to be higher in COVID-19 group and it was found that a confirmed prior COVID-19 might predict of abnormal MPI.


Subject(s)
COVID-19 , Coronary Artery Disease , Myocardial Ischemia , Myocardial Perfusion Imaging , Bayes Theorem , COVID-19/complications , Coronary Angiography/methods , Coronary Artery Disease/diagnostic imaging , Female , Humans , Middle Aged , Myocardial Ischemia/diagnostic imaging , Myocardial Perfusion Imaging/methods , Predictive Value of Tests , Retrospective Studies , SARS-CoV-2 , Tomography, Emission-Computed, Single-Photon/methods
11.
Heart Vessels ; 35(10): 1349-1359, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-1451965

ABSTRACT

Fractional flow reserve (FFR) assessed during adenosine-induced maximal hyperemia has emerged as a useful tool for the guidance of percutaneous coronary interventions (PCI). However, interindividual variability in the response to adenosine has been claimed as a major limitation to the use of adenosine for the measurement of FFR, carrying the risk of underestimating the severity of coronary stenoses, with potential negative prognostic consequences. Genetic variants of the adenosine receptor A2a (ADORA2A gene), located in the coronary circulation, have been involved in the modulation of the hyperemic response to adenosine. However, no study has so far evaluated the impact of the single nucleotide polymorphism rs5751876 of ADORA2A on the measurement of FFR in patients undergoing percutaneous coronary intervention that was, therefore, the aim of our study. We included patients undergoing coronary angiography and FFR assessment for intermediate (40-70%) coronary lesions. FFR measurement was performed by pressure-recording guidewire (Prime Wire, Volcano), after induction of hyperemia with intracoronary boli of adenosine (from 60 to 1440 µg, with dose doubling at each step). Restriction fragment length polymorphism (RFLP) analysis was performed to assess the presence of rs5751876 C>T polymorphism of ADORA2a receptor. We included 204 patients undergoing FFR measurement of 231 coronary lesions. A total of 134 patients carried the polymorphism (T allele), of whom 41 (30.6%) in homozygosis (T/T).Main clinical and angiographic features did not differ according to ADORA2A genotype. The rs5751876 C>T polymorphism did not affect mean FFR values (p = 0.91), the percentage of positive FFR (p = 0.54) and the duration of maximal hyperemia. However, the time to recovery to baseline FFR values was more prolonged among the T-allele carriers as compared to wild-type patients (p = 0.04). Based on these results, in patients with intermediate coronary stenoses undergoing FFR assessment with adenosine, the polymorphism rs5751876 of ADORA2A does not affect the peak hyperemic response to adenosine and the results of FFR. However, a more prolonged effect of adenosine was observed in T-carriers.


Subject(s)
Coronary Artery Disease/genetics , Coronary Stenosis/genetics , Fractional Flow Reserve, Myocardial/genetics , Polymorphism, Single Nucleotide , Receptor, Adenosine A2A/genetics , Adenosine/administration & dosage , Aged , Cardiac Catheterization , Coronary Angiography , Coronary Artery Disease/diagnosis , Coronary Artery Disease/physiopathology , Coronary Artery Disease/therapy , Coronary Stenosis/diagnosis , Coronary Stenosis/physiopathology , Coronary Stenosis/therapy , Female , Humans , Hyperemia/physiopathology , Male , Middle Aged , Percutaneous Coronary Intervention , Phenotype , Predictive Value of Tests , Severity of Illness Index , Vasodilator Agents/administration & dosage
12.
Heart ; 108(1): 46-53, 2022 01.
Article in English | MEDLINE | ID: covidwho-1455729

ABSTRACT

OBJECTIVES: To determine the contribution of comorbidities on the reported widespread myocardial abnormalities in patients with recent COVID-19. METHODS: In a prospective two-centre observational study, patients hospitalised with confirmed COVID-19 underwent gadolinium and manganese-enhanced MRI and CT coronary angiography (CTCA). They were compared with healthy and comorbidity-matched volunteers after blinded analysis. RESULTS: In 52 patients (median age: 54 (IQR 51-57) years, 39 males) who recovered from COVID-19, one-third (n=15, 29%) were admitted to intensive care and a fifth (n=11, 21%) were ventilated. Twenty-three patients underwent CTCA, with one-third having underlying coronary artery disease (n=8, 35%). Compared with younger healthy volunteers (n=10), patients demonstrated reduced left (ejection fraction (EF): 57.4±11.1 (95% CI 54.0 to 60.1) versus 66.3±5 (95 CI 62.4 to 69.8)%; p=0.02) and right (EF: 51.7±9.1 (95% CI 53.9 to 60.1) vs 60.5±4.9 (95% CI 57.1 to 63.2)%; p≤0.0001) ventricular systolic function with elevated native T1 values (1225±46 (95% CI 1205 to 1240) vs 1197±30 (95% CI 1178 to 1216) ms;p=0.04) and extracellular volume fraction (ECV) (31±4 (95% CI 29.6 to 32.1) vs 24±3 (95% CI 22.4 to 26.4)%; p<0.0003) but reduced myocardial manganese uptake (6.9±0.9 (95% CI 6.5 to 7.3) vs 7.9±1.2 (95% CI 7.4 to 8.5) mL/100 g/min; p=0.01). Compared with comorbidity-matched volunteers (n=26), patients had preserved left ventricular function but reduced right ventricular systolic function (EF: 51.7±9.1 (95% CI 53.9 to 60.1) vs 59.3±4.9 (95% CI 51.0 to 66.5)%; p=0.0005) with comparable native T1 values (1225±46 (95% CI 1205 to 1240) vs 1227±51 (95% CI 1208 to 1246) ms; p=0.99), ECV (31±4 (95% CI 29.6 to 32.1) vs 29±5 (95% CI 27.0 to 31.2)%; p=0.35), presence of late gadolinium enhancement and manganese uptake. These findings remained irrespective of COVID-19 disease severity, presence of myocardial injury or ongoing symptoms. CONCLUSIONS: Patients demonstrate right but not left ventricular dysfunction. Previous reports of left ventricular myocardial abnormalities following COVID-19 may reflect pre-existing comorbidities. TRIAL REGISTRATION NUMBER: NCT04625075.


Subject(s)
COVID-19 , Ventricular Dysfunction, Right/diagnostic imaging , Adult , Computed Tomography Angiography , Contrast Media , Coronary Angiography , Female , Humans , Magnetic Resonance Imaging, Cine , Male , Manganese/metabolism , Matched-Pair Analysis , Middle Aged , Myocardium/metabolism , Prospective Studies , Survivors , Systole/physiology , Ventricular Dysfunction, Right/physiopathology
15.
Crit Care ; 25(1): 217, 2021 06 24.
Article in English | MEDLINE | ID: covidwho-1388810

ABSTRACT

BACKGROUND: The viral load of asymptomatic SAR-COV-2 positive (ASAP) persons has been equal to that of symptomatic patients. On the other hand, there are no reports of ST-elevation myocardial infarction (STEMI) outcomes in ASAP patients. Therefore, we evaluated thrombus burden and thrombus viral load and their impact on microvascular bed perfusion in the infarct area (myocardial blush grade, MBG) in ASAP compared to SARS-COV-2 negative (SANE) STEMI patients. METHODS: This was an observational study of 46 ASAP, and 130 SANE patients admitted with confirmed STEMI treated with primary percutaneous coronary intervention and thrombus aspiration. The primary endpoints were thrombus dimension + thrombus viral load effects on MBG after PPCI. The secondary endpoints during hospitalization were major adverse cardiovascular events (MACEs). MACEs are defined as a composite of cardiovascular death, nonfatal acute AMI, and heart failure during hospitalization. RESULTS: In the study population, ASAP vs. SANE showed a significant greater use of GP IIb/IIIa inhibitors and of heparin (p < 0.05), and a higher thrombus grade 5 and thrombus dimensions (p < 0.05). Interestingly, ASAP vs. SANE patients had lower MBG and left ventricular function (p < 0.001), and 39 (84.9%) of ASAP patients had thrombus specimens positive for SARS-COV-2. After PPCI, a MBG 2-3 was present in only 26.1% of ASAP vs. 97.7% of SANE STEMI patients (p < 0.001). Notably, death and nonfatal AMI were higher in ASAP vs. SANE patients (p < 0.05). Finally, in ASAP STEMI patients the thrombus viral load was a significant determinant of thrombus dimension independently of risk factors (p < 0.005). Thus, multiple logistic regression analyses evidenced that thrombus SARS-CoV-2 infection and dimension were significant predictors of poorer MBG in STEMI patients. Intriguingly, in ASAP patients the female vs. male had higher thrombus viral load (15.53 ± 4.5 vs. 30.25 ± 5.51 CT; p < 0.001), and thrombus dimension (4.62 ± 0.44 vs 4.00 ± 1.28 mm2; p < 0.001). ASAP vs. SANE patients had a significantly lower in-hospital survival for MACE following PPCI (p < 0.001). CONCLUSIONS: In ASAP patients presenting with STEMI, there is strong evidence towards higher thrombus viral load, dimension, and poorer MBG. These data support the need to reconsider ASAP status as a risk factor that may worsen STEMI outcomes.


Subject(s)
COVID-19/complications , Coronary Thrombosis/virology , Heart/physiopathology , Microcirculation/physiology , Myocardial Infarction/physiopathology , Aged , Analysis of Variance , Asymptomatic Infections/epidemiology , COVID-19/epidemiology , Cohort Studies , Coronary Angiography/methods , Coronary Thrombosis/epidemiology , Echocardiography/methods , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Myocardial Infarction/epidemiology
17.
Cardiovasc Ultrasound ; 19(1): 31, 2021 Aug 24.
Article in English | MEDLINE | ID: covidwho-1371970

ABSTRACT

BACKGROUND: Cardiovascular complications of severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV2) are known to be associated with poor outcome. A small number of case series and reports have described cases of myocarditis and ischaemic events, however, knowledge on the aetiology of acute cardiac failure in SARS-CoV2 remains limited. We describe the occurrence and risk stratification imaging correlates of 'takotsubo' stress cardiomyopathy presenting in a patient with Coronavirus Disease 2019 (COVID-19) in the intensive care unit. An intubated 53-year old patient with COVID19 suffered acute haemodynamic collapse in the intensive care unit, and was thus investigated with transthoracic echocardiography (TTE), 12-lead electrocardiograms (ECG) and serial troponins and blood tests, and eventually coronary angiography due to clinical suspicion of ischaemic aetiology. Echocardiography revealed a reduced ejection fraction, with evident extensive apical akinesia spanning multiple coronary territories. Troponins and NT-proBNP were elevated, and ECG revealed ST elevation: coronary angiography was thus performed. This revealed no significant coronary stenosis. Repeat echocardiography performed within the following week revealed a substantial recovery of ejection fraction and wall motion abnormalities. Despite requirement of a prolonged ICU stay, the patient now remains clinically stable, and is on spontaneous breathing. CONCLUSION: This case report presents a case of takotsubo stress cardiomyopathy occurring in a critically unwell patient with COVID19 in the intensive care setting. Stress cardiomyopathy may be an acute cardiovascular complication of COVID-19 infection. In the COVID19 critical care setting, urgent bedside echocardiography is an important tool for initial clinical assessment of patients suffering haemodynamic compromise.


Subject(s)
COVID-19/epidemiology , Coronary Angiography/methods , Echocardiography/methods , Electrocardiography/methods , Takotsubo Cardiomyopathy/diagnosis , Comorbidity , Female , Humans , Middle Aged , Pandemics , Takotsubo Cardiomyopathy/epidemiology
18.
Indian Heart J ; 73(5): 549-554, 2021.
Article in English | MEDLINE | ID: covidwho-1370530

ABSTRACT

OBJECTIVE: Robotically assisted PCI offers a great alternative to S-PCI. This has gained even more relevance during the COVID-19 pandemic era however safety of R-PCI compared to S-PCI has not been studied well. This study explores the safety and efficacy of robotically assisted PCI (R-PCI) compared to standard PCI (S-PCI) for the treatment of coronary artery disease (CAD). METHODS: PubMed, Scopus, Ovid, and Google scholar databases were searched for studies comparing R-PCI to S-PCI. Outcomes included clinical success, procedure time, fluoroscopy time, contrast use and radiation exposure. RESULTS: Theauthors included 5 studies comprising 1555 patients in this meta-analysis. Clinical success was comparable in both arms (p = 0.91). Procedure time was significantly longer in R-PCI group (risk ratio: 5.52, 95% confidence interval: 1.85 to 9.91, p = 0.003). Compared to S-PCI, patients in R-PCI group had lower contrast use (meandifference: -19.88, 95% confidence interval: -21.43 to -18.33, p < 0.001), fluoroscopy time (mean difference:-1.82, 95% confidence interval: -3.64 to -0.00, p = 0.05) and radiation exposure (mean difference:-457.8, 95% confidence interval: -707.14 to -208.14, p < 0.001). CONCLUSION: R-PCI can achieve similar success as S-PCI at the expense of longer procedural times. However, radiation exposure and contrast exposure were lower in the R-PCI arm.


Subject(s)
COVID-19 , Coronary Artery Disease , Percutaneous Coronary Intervention , Robotic Surgical Procedures , Coronary Angiography , Coronary Artery Disease/diagnosis , Coronary Artery Disease/surgery , Feasibility Studies , Humans , Pandemics , SARS-CoV-2 , Treatment Outcome
19.
J Cardiol ; 79(4): 455-459, 2022 04.
Article in English | MEDLINE | ID: covidwho-1364267

ABSTRACT

Coronavirus disease-2019 (COVID-19) has a profound impact on the health care system worldwide. In the COVID-19 pandemic, hospitals are required to halt elective surgeries and procedures for preventing nosocomial infections and saving medical resources. In these situations, emergency procedures are required for life-threatening cardiovascular diseases such as acute coronary syndrome and cardiogenic shock. To prevent the spread of COVID-19, a social distance is essentially required. In ordinary percutaneous coronary intervention (PCI), operators manipulate the devices standing at the patient's tableside during the whole procedure, which may involve a certain risk of exposure to patients with COVID-19. A robotic-assisted PCI (R-PCI) allows operators to manipulate devices remotely, sitting at a cockpit located several meters away from the patient, and in addition, the assistant can be at the foot of the bed, much further from the access site. R-PCI can help to minimize the radiation exposure and the amount of person-to-person contact, and consequently may reduce the risk for the exposure to the virus.


Subject(s)
COVID-19 , Coronary Artery Disease , Percutaneous Coronary Intervention , Robotic Surgical Procedures , Coronary Angiography , Coronary Artery Disease/surgery , Humans , Pandemics , Percutaneous Coronary Intervention/adverse effects , SARS-CoV-2 , Treatment Outcome
20.
Am J Cardiol ; 157: 42-47, 2021 10 15.
Article in English | MEDLINE | ID: covidwho-1356116

ABSTRACT

Cardiac involvement in coronavirus disease 2019 (COVID-19) has been established. This is manifested by troponin elevation and associated with worse patient prognosis. We evaluated whether patient outcomes improved as experience accumulated during the pandemic. We analyzed COVID-19-positive patients with myocardial injury (defined as troponin elevation) who presented to the MedStar Health system (11 hospitals in Washington, DC, and Maryland) during the "Early Phase" of the pandemic (March 1 - June 30, 2020) and compared their characteristics and outcomes to the COVID-19-positive patients with the presence of troponin elevation in the "Later Phase" of the pandemic (October 1, 2020 - January 31, 2021). The cohort included 788 COVID-19-positive admitted patients for whom troponin was elevated, 167 during the "Early Phase" and 621 during the "Later Phase." Maximum troponin-I in the "Early Phase" was 13.46±34.72 ng/mL versus 11.21±20.57 ng/mL in the "Later Phase" (p = 0.553). In-hospital mortality was significantly higher in the "Later Phase" (50.3% vs. 24.6%; p<0.001), as were incidence of intensive-care-unit admission (77.8% vs. 46.1%; p<0.001) and need for mechanical ventilation (61.7% versus 28%; p<0.001). In addition, more "Early Phase" patients underwent coronary angiography (6% vs. 2.3%; p=0.013). Finally, 3% of "Early Phase" and 0.8% of "Later Phase" patients underwent percutaneous coronary intervention (p=0.025). In conclusion, treatment outcomes have significantly improved since the beginning of the pandemic in COVID-19-positive patients with troponin elevation. This may be attributed to awareness, severity of the disease, improvements in therapies, and provider experience.


Subject(s)
COVID-19/epidemiology , Myocardial Infarction/therapy , Troponin I/blood , Aged , Aged, 80 and over , Clinical Competence , Cohort Studies , Coronary Angiography/statistics & numerical data , District of Columbia/epidemiology , Female , Hospital Mortality , Humans , Intensive Care Units , Male , Maryland/epidemiology , Middle Aged , Myocardial Infarction/epidemiology , Pandemics , Patient Admission/statistics & numerical data , Percutaneous Coronary Intervention/statistics & numerical data , Respiration, Artificial/statistics & numerical data
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