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1.
Am J Med Case Rep ; 8(7): 192-196, 2020.
Article in English | MEDLINE | ID: covidwho-1989680

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a pandemic that started in the Wuhan province of China in December 2019. It is associated with increased morbidity and mortality mainly due to severe acute respiratory syndrome 2 (SARS-Cov-2). Cardiac manifestations related to COVID-19 include demand ischemia, fulminant myocarditis, myocardial infarction and arrhythmias. In this report, we present a case of ST-segment elevation myocardial infarction (STEMI) in a 68-year-old man with COVID-19 who initially presented with chest pain and shortness of breath. Patient's STEMI was managed with pharmaco-invasive strategy with tissue plasminogen activator (t-PA). He then developed acute hypoxic respiratory failure that was managed in the intensive care unit (ICU), together with multi-organ failure from which the patient died 2 days after presentation. Although the pathophysiologic mechanisms of STEMI in COVID-19 patients has not been clearly established, we hypothesize that interrelated pathogenetic factors, that we highlight in this report, can play a role in the development of STEMI, including plaque rupture secondary to systemic inflammation, increased pro-coagulants, endothelial dysfunction, impaired fibrinolysis and impaired oxygen utilization leading to demand/supply mismatch and myocardial ischemia.

2.
Minerva Cardiol Angiol ; 70(4): 421-427, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1975635

ABSTRACT

BACKGROUND: On March 9, 2020, the Italian government imposed a national lockdown to tackle the COronaVIrus Disease 19 (COVID-19) pandemic, including stay at home recommendations. The precise impact of COVID-19 scare and lockdown on emergency access for acute myocardial infarction (MI) is still subject to debate. METHODS: Data on all patients undergoing invasive coronary angiography at 9 hospitals in the greater area of Rome, Italy, between February 19, 2020 and March 29, 2020 were retrospectively collected. Incidence of ST-elevation MI (STEMI), and non-ST-elevation MI (NSTEMI), as well as corresponding percutaneous coronary intervention (PCI), was compared distinguishing two different 20-day time periods (before vs. on or after March 10, 2020). RESULTS: During the study period, 1068 patients underwent coronary angiography, 142 (13%) with STEMI and 169 (16%) with NSTEMI. The average daily number of STEMI decreased from 4.3 before the lockdown to 2.9 after the lockdown (P=0.021). Similarly, the average daily number of NSTEMI changed from 5.0 to 3.5 (P=0.028). The average daily number of primary PCI changed from 4.2 to 2.9 (P=0.030), while the average daily number of PCI for NSTEMI changed from 3.5 to 2.5 (P=0.087). For STEMI patients, the time from symptom onset to hospital arrival (onset-to-door time less than three hours) showed a significant increase after the lockdown (P=0.018), whereas door-to-balloon time did not change significantly from before to after the lockdown (P=0.609). CONCLUSIONS: The present study, originally reporting on the trends in STEMI and NSTEMI in the Rome area, highlights that significant decreases in the incidence of both acute coronary syndromes occurred between February 19, 2020 and March 29, 2020, together with increases in time from symptom onset to hospital arrival, luckily without changes in door-to-balloon time.


Subject(s)
COVID-19 , Myocardial Infarction , Non-ST Elevated Myocardial Infarction , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , COVID-19/epidemiology , Communicable Disease Control , Humans , Myocardial Infarction/epidemiology , Myocardial Infarction/therapy , Non-ST Elevated Myocardial Infarction/diagnosis , Non-ST Elevated Myocardial Infarction/epidemiology , Non-ST Elevated Myocardial Infarction/therapy , Pandemics/prevention & control , Retrospective Studies , Rome/epidemiology , ST Elevation Myocardial Infarction/epidemiology , ST Elevation Myocardial Infarction/surgery
3.
J Am Coll Clin Pharm ; 3(6): 1138-1146, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-1898810

ABSTRACT

The recent coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) challenges pharmacists worldwide. Alongside other specialized pharmacists, we re-evaluated daily processes and therapies used to treat COVID-19 patients within our institutions from a cardiovascular perspective and share what we have learned. To develop a collaborative approach for cardiology issues and concerns in the care of confirmed or suspected COVID-19 patients by drawing on the experiences of cardiology pharmacists across the country. On March 26, 2020, a conference call was convened composed of 24 cardiology residency-trained pharmacists (23 actively practicing in cardiology and 1 in critical care) from 16 institutions across the United States to discuss cardiology issues each have encountered with COVID-19 patients. Discussion centered around providing optimal pharmaceutical care while limiting staff exposure. The collaborative of pharmacists found for the ST-elevation myocardial infarction patient, many institutions were diverting COVID-19 rule-out patients to their Emergency Department (ED). Thrombolytics are an alternative to percutaneous coronary intervention (PCI) allowing for timely treatment of patients and decreased staff exposure. An emergency response grab and go kit includes initial drugs and airway equipment so the patient can be treated and the cart can be left outside the room. Cardiology pharmacists have developed policies and procedures to address monitoring of QT prolonging medications, the use of inhaled prostacyclins, and national drug shortages. Technology has allowed us to practice social distancing, while staying in close contact with our teams, patients, and colleagues and continuing to teach. Residents are engaged in unique decision-making processes with their preceptors and assist as pharmacist extenders. Cardiology pharmacists are in a unique position to work with other pharmacists and health care professionals to implement safe and effective practice changes during the COVID-19 pandemic. Ongoing monitoring and adjustments are necessary in rapidly changing times.

4.
Minerva Cardiol Angiol ; 70(3): 303-309, 2022 06.
Article in English | MEDLINE | ID: covidwho-1841790

ABSTRACT

BACKGROUND: The Lombardy region, in Northern Italy, suffered a major outbreak of Coronavirus disease 2019 (COVID-19) at the end of February 2020. The health system was rapidly overwhelmed by the pandemic. It became evident that patients suffering from time-sensitive medical emergencies like stroke, cerebral hemorrhage, trauma and acute myocardial infarction required timely, effective and safe pathways to be treated. The problem was addressed by a regional decree that created a hub-and-spoke system for time-sensitive medical emergencies. METHODS: We report the re-organizational changes adopted at a hub hospital (despite having already destined to COVID-19 patients most resources), and the number of emergent procedures for medical emergencies on the first 30-day of activity. These data were compared with the hospital activity in the same period of the previous year. RESULTS: Organizational changes were implemented in few hours. Dedicated pathways for non-COVID-19 patients affected by a medical emergency were set up in the emergency department, in the labs and in the operating theater. Ten intensive beds were implemented from a high-dependency unit; two operating rooms were reserved 24 h/day to neurosurgical or trauma emergencies. The number of emergent procedures was not different from that of the previous year, no admission refusal, no treatment delay and no viral transmission to the treated patients were recorded. No viral transmission to health care workers was observed. CONCLUSIONS: Re-organization of a hospital in order to adopt a hub-and-spoke model resulted feasible and allowed to face acute coronary syndrome and other time-sensitive medical emergencies timely and safely.


Subject(s)
Acute Coronary Syndrome , COVID-19 , COVID-19/epidemiology , Emergencies , Humans , Pandemics , SARS-CoV-2
5.
J Thromb Thrombolysis ; 53(2): 321-334, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1729348

ABSTRACT

OBJECTIVE: We aimed to investigate both the impact of COVID-19 pandemic on ST-segment elevation myocardial infarction (STEMI) admission, and demographic, angiographic, procedural characteristics, and in-hospital clinical outcomes of patients with COVID-19 positive STEMI in Turkey. METHODS: This was a multi-center and cross-sectional observational study. The study population included 1788 STEMI patients from 15 centers in Turkey. The patients were divided into two groups: COVID-19 era (March 11st-May 15st, 2020; n = 733) or pre- COVID-19 era group (March 11st-May 15st, 2019; n = 1055). Also, the patients in COVID-19 era were grouped as COVID-19 positive (n = 65) or negative (n = 668). RESULTS: There was a 30.5% drop in STEMI admission during COVID-19 era in comparison to pre-COVID-19 era. The patients admitted to the medical centers during COVID-19 era had a longer symptom-to-first medical contact time [120 (75-240) vs. 100 (60-180) minutes, p < 0.001]. COVID-19 positive STEMI patients had higher thrombus grade and lower left ventricular ejection fraction compared to COVID-19 negative patients. COVID-19 positive patients had higher mortality (28% vs. 6%, p < 0.001) and cardiogenic shock (20% vs. 7%, p < 0.001) rates compared with those without COVID-19. Matching based on propensity scores showed higher mortality and high thrombus grade in STEMI patients who were infected by SARS-COV-2 (each p < 0.05). CONCLUSIONS: We detected significantly lower STEMI hospitalization rates and significant delay in duration of symptom onset to first medical contact in the context of Turkey during the COVID-19 outbreak. Moreover, high thrombus grade and mortality were more common in COVID-19 positive STEMI patients.


Subject(s)
COVID-19 , ST Elevation Myocardial Infarction , COVID-19/epidemiology , Cross-Sectional Studies , Hospitalization/statistics & numerical data , Humans , Pandemics , Registries , SARS-CoV-2 , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/mortality , Stroke Volume , Time-to-Treatment , Turkey/epidemiology , Ventricular Function, Left
6.
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
7.
Adv Exp Med Biol ; 1318: 263-291, 2021.
Article in English | MEDLINE | ID: covidwho-1536207

ABSTRACT

We herein seek to expound on up-to-the-minute information regarding cardiovascular disease in the era of coronavirus disease 2019 (COVID-19) by highlighting acute myocardial injury caused by COVID-19 and probing into its pathophysiology, clinical signs, diagnostic tests, and treatment modalities. We aim to share the latest research findings vis-à-vis cardiovascular disease patients with confirmed or suspected COVID-19 on the association between hypertension and this infectious disease along with the relevant recommendations; describe the mechanism of coronary artery disease in such patients together with the necessary measures in the setting of non-ST-segment elevation acute coronary syndrome, ST-segment elevation myocardial infarction, and chronic coronary syndrome; discuss tachy- and bradyarrhythmias in the COVID-19 setting alongside their treatments; elucidate coagulopathies, venous thromboembolism, and its prophylactic measures in the context of this infection; set out the cardiopulmonary resuscitation protocol as well as the pertinent safety concerns during the current pandemic; and, finally, explicate drug-drug interactions between COVID-19 and cardiovascular medication in hypertension, acute coronary syndrome, heart failure, venous thromboembolism, and arrhythmias.


Subject(s)
COVID-19 , Cardiovascular Diseases , ST Elevation Myocardial Infarction , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Humans , Pandemics , SARS-CoV-2
8.
J Thromb Thrombolysis ; 52(4): 1047-1055, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1525568

ABSTRACT

To estimate the impact on emergency attendance for stroke and acute myocardial infarction (AMI) during the pandemic of COVID-19 in Beijing, China. Based on 17,123 and 8693 emergency attendance for stroke and AMI, an interrupted time-series (ITS) study was conducted. Since 01/24/2020, the top two levels of regulations on major public health have been implemented in Beijing. This study covered from 03/01/2018 to 06/03/2020, including 19 weeks of lockdown period and 99 weeks before. A segmented Poisson regression model was used to estimate the immediate change and the monthly change in the secular trend of the emergency attendance rates. The emergency attendance rates of stroke and AMI cut in half at the beginning of the lockdown period, with 52.1% (95% CI 45.8% to 57.7%) and 63.1% (95% CI 56.1% to 63.1%) immediate decreases for stroke and AMI, respectively. Then during the lockdown period, 7.0% (95% CI 2.5%, 11.6%) and 16.1% (95% CI 9.5, 23.1) increases per month in the secular trends of emergency attendance rates were shown for stroke and AMI, respectively. Though the accelerated increasing rates, there were estimated 1335 and 747 patients with stroke and AMI without seeking emergency medical aid during the lockdown, respectively. The emergency attendance for stroke and AMI cut in half at the beginning of the pandemic then had gradual restoration thereafter. The results hint the need for more engagement and communications with all stakeholders to reduce the negative impact on CVD emergency medical services during the crisis.


Subject(s)
COVID-19 , Emergency Medical Services/statistics & numerical data , Myocardial Infarction , Stroke , Beijing , Humans , Interrupted Time Series Analysis , Myocardial Infarction/epidemiology , Myocardial Infarction/therapy , Pandemics , Stroke/epidemiology , Stroke/therapy
9.
Gac Med Mex ; 156(6): 559-569, 2020.
Article in English | MEDLINE | ID: covidwho-1503050

ABSTRACT

INTRODUCTION: Mexico has the highest 30-day mortality due to acute myocardial infarction (AMI), which constitutes one of the main causes of mortality in the country: 28 % versus 7.5 % on average for the Organization for Economic Co-operation and Development member countries. OBJECTIVE: To establish critical pathways and essential interinstitutional pharmacological strategies for the care of patients with AMI in Mexico, regardless of their socioeconomic status. METHOD: A group of experts in AMI diagnosis and treatment, representatives of the main public health institutions in Mexico, as well as the Mexican cardiology societies, the Mexican Red Cross and representatives of the Spanish Society of Cardiology, were brought together in order to optimize strategies based on the best existing evidence. RESULTS: An interinstitutional clinical practice guideline was designed for early diagnosis and timely treatment of AMI with ST-segment elevation, following the clinical horizon of the disease, with the proposal of algorithms that improve the prognosis of patients who attend the emergency services due to an AMI. CONCLUSION: With these clinical practice guidelines, the group of experts proposes to universalize AMI diagnosis and treatment, regardless of patient socioeconomic status. INTRODUCCIÓN: México tiene la mortalidad más alta a 30 días por infarto agudo de miocardio (IAM), el cual constituye una de las principales causas de mortalidad en el país: 28 % versus 7.5 % del promedio de los países de la Organización para la Cooperación y el Desarrollo Económicos. OBJETIVO: Establecer las rutas críticas y las estrategias farmacológicas esenciales interinstitucionales para la atención de los pacientes con IAM en México, independientemente de su condición socioeconómica. MÉTODO: Se reunió a un grupo de expertos en diagnóstico y tratamiento de IAM, representantes de las principales instituciones públicas de salud de México, así como las sociedades cardiológicas mexicanas, Cruz Roja Mexicana y representantes de la Sociedad Española de Cardiología con la finalidad de optimizar las estrategias con base en la mejor evidencia existente. RESULTADOS: Se diseñó una guía de práctica clínica interinstitucional para el diagnóstico temprano y tratamiento oportuno del IAM con elevación del segmento ST, siguiendo el horizonte clínico de la enfermedad, con la propuesta de algoritmos que mejoren el pronóstico de los pacientes que acuden por IAM a los servicios de urgencias. CONCLUSIÓN: Con la presente guía práctica, el grupo de expertos propone universalizar el diagnóstico y tratamiento en el IAM, independientemente de la condición socioeconómica del paciente.


Subject(s)
Consensus , ST Elevation Myocardial Infarction/diagnosis , Biomarkers/blood , COVID-19/prevention & control , Cardiac Rehabilitation , Cause of Death , Electrocardiography , Humans , Mexico , Myocardial Reperfusion/methods , Percutaneous Coronary Intervention/methods , ST Elevation Myocardial Infarction/blood , ST Elevation Myocardial Infarction/rehabilitation , Societies, Medical , Spain , Thrombolytic Therapy/methods
10.
BMJ Open ; 11(4): e047134, 2021 04 13.
Article in English | MEDLINE | ID: covidwho-1455715

ABSTRACT

BACKGROUND: Cardiac rehabilitation (CR) decreases the morbidity and mortality risk among patients with cardiac diseases; however, the impact of CR on patients with diabetes remains underexplored. This is a protocol for a systematic review and meta-analysis methodology to explore if the effect of CR on mortality and morbidity is the same in patients with type 2 diabetes compared with patients without diabetes. METHODS AND ANALYSIS: Interventional and non-interventional studies comparing the effect of CR, for at least 1 month, on all-cause mortality and cardiovascular outcomes including fatal and non-fatal myocardial infarction, revascularisation and rehospitalisation in adults with cardiac diseases will be deemed eligible for inclusion. Studies published between 1990 and 2020 will be searched in PubMed, Embase, Cochrane, CINAHL, Scopus and in registries for randomised controlled trials. Eligible studies will be selected using the Covidence software, and their salient details regarding the design, population, tested interventions and outcomes of interest will be gathered. The quality of studies to be deemed eligible and reviewed will be assessed using the Cochrane Collaboration and National Heart, Lung, and Blood Institute's tools. The appraisal process will be based on the study design (interventional and non-interventional). In the meta-analysis step, the pooled effect of CR on the outcomes will be estimated. All meta-analyses will be done using the random-effects model approach (inverse-variance method). I 2 and p value of χ2 statistics will guide the heterogeneity assessment. Subgroup analyses will also be performed. The small study effect will be investigated by generating the funnel plots. The symmetry of the latter will be tested by performing Egger's test. ETHICS AND DISSEMINATION: The systematic review will use data from published literature; hence, no ethical approval will be required. Findings of the systematic review and meta-analysis will be published in peer-reviewed international journals and will be disseminated in local and international scientific meetings. PROSPERO REGISTRATION NUMBER: CRD42020148832.


Subject(s)
Cardiac Rehabilitation , Diabetes Mellitus, Type 2 , Myocardial Infarction , Adult , Humans , Meta-Analysis as Topic , Morbidity , Research Design , Systematic Reviews as Topic
11.
Can J Cardiol ; 37(9): 1450-1459, 2021 09.
Article in English | MEDLINE | ID: covidwho-1397231

ABSTRACT

BACKGROUND: The COVID-19 pandemic has affected patients with ST-segment elevation myocardial infarction (STEMI) requiring primary percutaneous coronary intervention (PCI) worldwide. In this review we examine the global effect of the COVID-19 pandemic on incidence of STEMI admissions, and relationship between the pandemic and door to balloon time (D2B), all-cause mortality, and other secondary STEMI outcomes. METHODS: We performed a systematic review and meta-analysis to primarily compare D2B time and in-hospital mortality of STEMI patients who underwent primary PCI during and before the pandemic. Subgroup analyses were performed to investigate the influence of geographical region and income status of a country on STEMI care. An online database search included studies that compared the aforementioned outcomes of STEMI patients during and before the pandemic. RESULTS: In total, 32 articles were analyzed. Overall, 19,140 and 68,662 STEMI patients underwent primary PCI during and before the pandemic, respectively. Significant delay in D2B was observed during the pandemic (weighted mean difference, 8.10 minutes; 95% confidence interval [CI], 3.90-12.30 minutes; P = 0.0002; I2 = 90%). In-hospital mortality was higher during the pandemic (odds ratio [OR], 1.27; 95% CI, 1.09-1.49; P = 0.002; I2 = 36%), however this varied with factors such as geographical location and income status of a country. Subgroup analysis showed that low-middle-income countries observed a higher rate of mortality during the pandemic (OR, 1.52; 95% CI, 1.13-2.05; P = 0.006), with a similar but insignificant trend seen among the high income countries (OR, 1.17; 95% CI, 0.95-1.44; P = 0.13). CONCLUSIONS: The COVID-19 pandemic is associated with worse STEMI performance metrics and clinical outcome, particularly in the Eastern low-middle-income status countries. Better strategies are needed to address these global trends in STEMI care during the pandemic.


Subject(s)
COVID-19 , Pandemics , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction/therapy , COVID-19/epidemiology , Databases, Factual , Hospital Mortality , Humans , Internationality , Pandemics/statistics & numerical data , Patient Admission/statistics & numerical data , Percutaneous Coronary Intervention/statistics & numerical data , SARS-CoV-2 , ST Elevation Myocardial Infarction/epidemiology , ST Elevation Myocardial Infarction/mortality , Time Factors , Time-to-Treatment/statistics & numerical data , Treatment Outcome
12.
PLoS One ; 15(10): e0241149, 2020.
Article in English | MEDLINE | ID: covidwho-1388891

ABSTRACT

INTRODUCTION: Early reports described decreased admissions for acute cardiovascular events during the SarsCoV-2 pandemic. We aimed to explore whether the lockdown enforced during the SARSCoV-2 pandemic in Israel impacted the characteristics of presentation, reperfusion times, and early outcomes of ST-elevation myocardial infarction (STEMI) patients. METHODS: A multicenter prospective cohort comprising all STEMI patients treated by primary percutaneous coronary intervention admitted to four high-volume cardiac centers in Israel during lockdown (20/3/2020-30/4/2020). STEMI patients treated during the same period in 2019 served as controls. RESULTS: The study comprised 243 patients, 107 during the lockdown period of 2020 and 136 during the same period in 2019, with no difference in demographics and clinical characteristics. Patients admitted in 2020 had higher admission and peak troponin levels, had a 2.4 fold greater likelihood of Door-to-balloon times> 90 min (95%CI: 1.2-4.9, p = 0.01) and 3.3 fold greater likelihood of pain-to-balloon times> 12 hours (OR 3.3, 95%CI: 1.3-8.1, p<0.01). They experienced higher rates hemodynamic instability (25.2% vs 14.7%, p = 0.04), longer hospital stay (median, IQR [4, 3-6 Vs 5, 4-6, p = 0.03]), and fewer early (<72 hours) discharge (12.4% Vs 32.4%, p<0.001). CONCLUSIONS: The lockdown imposed during the SARSCoV-2 pandemic was associated with a significant lag in the time to reperfusion of STEMI patients. Measures to improves this metric should be implemented during future lockdowns.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control/standards , Patient Admission/statistics & numerical data , ST Elevation Myocardial Infarction/surgery , Time-to-Treatment/statistics & numerical data , Aged , COVID-19/epidemiology , COVID-19/transmission , COVID-19/virology , Female , Humans , Israel/epidemiology , Length of Stay/statistics & numerical data , Male , Middle Aged , Pandemics/prevention & control , Patient Admission/standards , Patient Discharge/statistics & numerical data , Percutaneous Coronary Intervention/statistics & numerical data , Prospective Studies , Registries/statistics & numerical data , SARS-CoV-2/pathogenicity , ST Elevation Myocardial Infarction/diagnosis , Time Factors , Treatment Outcome
13.
Dtsch Arztebl Int ; 118(26): 447-453, 2021 07 02.
Article in English | MEDLINE | ID: covidwho-1360700

ABSTRACT

BACKGROUND: The phenomenon of declining numbers of patients presenting with myocardial infarction was reported from the beginning of the COVID-19 pandemic onward. It was thought that measures introduced to stem the pandemic, such as the lockdown, contributed to this development. However, the data on hospital admissions, delay times, and mortality are not consistent. METHODS: Our systematic literature review and meta-analysis embraced studies reporting the number of hospital admissions of patients with ST-segment elevation myocardial infarction (STEMI) and/or non-ST-segment elevation myocardial infarction (NSTEMI) during lockdown episodes. We also collected data on patient- and system-related delay times and on mortality. RESULTS: Data from 27 studies on a total of 81 163 patients were included in our meta-analysis. We found that the number of hospital admissions of patients with myocardial infarction was significantly lower during the lockdown than before the pandemic (incidence rate ratio [IRR] = 0.516 [0.403; 0.660], I2 = 98%). This was true both for patients with STEMI (IRR = 0.620 [0.514; 0.746], I2 = 96%) and for patients with NSTEMI (IRR = 0.454 [0.354; 0.584], I2 = 96%). However, we found no significant difference in the time from hospital admission to cardiac catheterization, or in mortality, in relation to the time from symptom onset to first medical contact. CONCLUSION: In this study, we have shown that the lockdown due to COVID-19 was associated with a marked decline in the number of hospital admissions of patients with myocardial infarction. As no significant effect on delay times or mortality was observed, it seems that timely medical care continued to be delivered.


Subject(s)
COVID-19 , Myocardial Infarction , Communicable Disease Control , Humans , Myocardial Infarction/epidemiology , Pandemics , SARS-CoV-2
14.
PLoS One ; 16(6): e0253524, 2021.
Article in English | MEDLINE | ID: covidwho-1278202

ABSTRACT

BACKGROUND: We aimed to describe the characteristics and in-hospital outcomes of ST-segment elevation myocardial infarction (STEMI) patients during the Covid-19 era. METHODS: We conducted a prospective, multicenter study involving 13 intensive cardiac care units, to evaluate consecutive STEMI patients admitted throughout an 8-week period during the Covid-19 outbreak. These patients were compared with consecutive STEMI patients admitted during the corresponding period in 2018 who had been prospectively documented in the Israeli bi-annual National Acute Coronary Syndrome Survey. The primary end-point was defined as a composite of malignant arrhythmia, congestive heart failure, and/or in-hospital mortality. Secondary outcomes included individual components of primary outcome, cardiogenic shock, mechanical complications, electrical complications, re-infarction, stroke, and pericarditis. RESULTS: The study cohort comprised 1466 consecutive acute MI patients, of whom 774 (53%) were hospitalized during the Covid-19 outbreak. Overall, 841 patients were diagnosed with STEMI: 424 (50.4%) during the Covid-19 era and 417 (49.6%) during the parallel period in 2018. Although STEMI patients admitted during the Covid-19 period had fewer co-morbidities, they presented with a higher Killip class (p value = .03). The median time from symptom onset to reperfusion was extended from 180 minutes (IQR 122-292) in 2018 to 290 minutes (IQR 161-1080, p < .001) in 2020. Hospitalization during the Covid-19 era was independently associated with an increased risk of the combined endpoint in the multivariable regression model (OR 1.65, 95% CI 1.03-2.68, p value = .04). Furthermore, the rate of mechanical complications was four times higher during the Covid-19 era (95% CI 1.42-14.8, p-value = .02). However, in-hospital mortality remained unchanged (OR 1.73, 95% CI 0.81-3.78, p-value = .16). CONCLUSIONS: STEMI patients admitted during the first wave of Covid-19 outbreak, experienced longer total ischemic time, which was translated into a more severe disease status upon hospital admission, and a higher rate of in-hospital adverse events, compared with parallel period.


Subject(s)
COVID-19/prevention & control , Hospitalization/statistics & numerical data , Outcome Assessment, Health Care/statistics & numerical data , Registries/statistics & numerical data , SARS-CoV-2/isolation & purification , ST Elevation Myocardial Infarction/therapy , Aged , COVID-19/epidemiology , COVID-19/virology , Comorbidity , Epidemics , Female , Humans , Incidence , Logistic Models , Male , Middle Aged , Multivariate Analysis , Outcome Assessment, Health Care/methods , Prospective Studies , SARS-CoV-2/physiology , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/epidemiology
15.
Eur J Case Rep Intern Med ; 8(5): 002575, 2021.
Article in English | MEDLINE | ID: covidwho-1268424

ABSTRACT

During the COVID-19 pandemic, healthcare systems have faced unprecedented pressures. One challenge has been to promptly recognise non-COVID-19 conditions. Cognitive bias due to the availability heuristic may cause difficulties in reaching the correct diagnosis. Confirmation bias may also affect imaging interpretation. We report three cases with an alternative final diagnosis in whom COVID-19 was initially suspected: (a) Pneumocystis jirovecii pneumonia with unrecognised HIV infection; (b) pulmonary lymphangitis carcinomatosis; and (c) ST elevation myocardial infarction causing acute pulmonary oedema. To help mitigate bias, there is no substitute for thoughtful clinical assessment and critical appraisal when evaluating new information and formulating the differential diagnosis. LEARNING POINTS: The availability heuristic during the recent pandemic may lead to cognitive bias in favour of COVID-19 diagnosis and delayed recognition of other conditions, especially in patients presenting with similar non-specific features.Confirmation bias towards COVID-19 can also affect the interpretation of pulmonary imaging which is central to the investigation of cases with suspected pneumonitis.Diagnostic bias can be mitigated by recognition and allowing time for a thorough clinical history and methodical examination of the patients.

16.
Int J Cardiol Heart Vasc ; 35: 100824, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1267693

ABSTRACT

BACKGROUND: An increase in the time from the symptoms onset to first medical contact and to primary percutaneous coronary intervention (pPCI) has been observed in countries with high-incidence of COVID-19 cases. We aimed to verify if there was any change in the patient delay and in the EMS response times up to the pPCI for STEMI patients in Swiss Ticino Canton. METHODS: We assessed STEMI management including time from symptoms onset to EMS call, time of EMS response, time to pPCI in Swiss Canton Ticino. Data were retrieved from the Acute-Coronary-Syndrome-Ticino-Registry. We considered the patients included in the registry from March to May 2020 (pandemic period) and then from June to August 2020 (post-pandemic period) in whom a pPCI was performed. We compared these patients to those undergoing a pPCI in the same months in the year 2016-2019. RESULTS: During the pandemic period, the time from symptoms onset to pPCI significantly increased compared to non-pandemic periods. This was due to a significant prolongation of the time from symptoms onset to EMS call, that nearly tripled. In contrast, after the pandemic period, there was a significantly shorter time from symptom onset to EMS call compared to non-pandemic years, whereas all other times remained unchanged. CONCLUSION: Patients delay the call to EMS despite symptoms of myocardial infarction during the COVID-19 pandemic also in a region with a relatively low incidence of COVID-19.

17.
Dtsch Arztebl Int ; 118(26): 447-453, 2021 07 02.
Article in English | MEDLINE | ID: covidwho-1266652

ABSTRACT

BACKGROUND: The phenomenon of declining numbers of patients presenting with myocardial infarction was reported from the beginning of the COVID-19 pandemic onward. It was thought that measures introduced to stem the pandemic, such as the lockdown, contributed to this development. However, the data on hospital admissions, delay times, and mortality are not consistent. METHODS: Our systematic literature review and meta-analysis embraced studies reporting the number of hospital admissions of patients with ST-segment elevation myocardial infarction (STEMI) and/or non-ST-segment elevation myocardial infarction (NSTEMI) during lockdown episodes. We also collected data on patient- and system-related delay times and on mortality. RESULTS: Data from 27 studies on a total of 81 163 patients were included in our meta-analysis. We found that the number of hospital admissions of patients with myocardial infarction was significantly lower during the lockdown than before the pandemic (incidence rate ratio [IRR] = 0.516 [0.403; 0.660], I2 = 98%). This was true both for patients with STEMI (IRR = 0.620 [0.514; 0.746], I2 = 96%) and for patients with NSTEMI (IRR = 0.454 [0.354; 0.584], I2 = 96%). However, we found no significant difference in the time from hospital admission to cardiac catheterization, or in mortality, in relation to the time from symptom onset to first medical contact. CONCLUSION: In this study, we have shown that the lockdown due to COVID-19 was associated with a marked decline in the number of hospital admissions of patients with myocardial infarction. As no significant effect on delay times or mortality was observed, it seems that timely medical care continued to be delivered.


Subject(s)
COVID-19 , Myocardial Infarction , Communicable Disease Control , Humans , Myocardial Infarction/epidemiology , Pandemics , SARS-CoV-2
18.
Turk Kardiyol Dern Ars ; 49(4): 293-302, 2021 06.
Article in English | MEDLINE | ID: covidwho-1262652

ABSTRACT

OBJECTIVE: Acute ischemic cardiac events can complicate coronavirus disease 2019 (COVID-19). We report the in-hospital characteristics of patients with acute myocardial infarction and concomitant COVID-19. METHODS: This was a registry-based retrospective analysis of patients admitted with positive COVID-19 tests who suffered acute myocardial infarction either before or during hospitalization; from 1 March 2020 to 1 April 2020 in a tertiary cardiovascular center-Tehran Heart Center. We performed an exploratory analysis to compare the clinical characteristics of patients who died during hospitalization or were discharged alive. RESULTS: In March 2020, 57 patients who had acute myocardial infarction and a confirmed diagnosis of COVID-19 were included in the study. During hospitalization, 13 patients (22.8%) died after a mean hospital stay of 8.4 days. The deceased were older than the survivors. No significant association between mortality and sex or length of hospital stay was observed. Hypertensive individuals were more likely to have a fatal outcome. Previously receiving angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers did not show any association with mortality. Regarding the laboratory data during hospitalization, higher cardiac troponin T, neutrophil count, C-reactive protein, urea, and blood urea nitrogen/creatinine ratio were observed in the mortality group. The deceased had a lower lymphocyte count than the survivors. CONCLUSIONS: Markers of worsening renal function and immune system disturbance seem to be associated with mortality in concurrent acute myocardial infarction and COVID-19. Optimizing the management of acute coronary syndrome complicating COVID-19 requires addressing such potential contributors to mortality.


Subject(s)
COVID-19 , Myocardial Infarction , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/mortality , Female , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Myocardial Infarction/complications , Myocardial Infarction/diagnosis , Myocardial Infarction/epidemiology , Myocardial Infarction/mortality , Retrospective Studies
19.
PLoS One ; 16(6): e0252351, 2021.
Article in English | MEDLINE | ID: covidwho-1262545

ABSTRACT

BACKGROUND: COVID-19 may predispose to both venous and arterial thromboembolism event (TEE). Reports on the prevalence and prognosis of thrombotic complications are still emerging. OBJECTIVE: To describe the rate of TEE complications and its influence in the prognosis of hospitalized patients with COVID-19 after a cross-sectional study. METHODS: We evaluated the prevalence of TEE and its relationship with in-hospital death among hospitalized patients with COVID-19 who were admitted between 1st March to 20th April 2020 in a multicentric network of sixteen Hospitals in Spain. TEE was defined by the occurrence of venous thromboembolism (VTE), acute ischemic stroke (AIS), systemic arterial embolism or myocardial infarction (MI). RESULTS: We studied 1737 patients with proven COVID-19 infection of whom 276 died (15.9%). TEE were presented in 64 (3.7%) patients: 49 (76.6%) patients had a VTE, 8 (12.5%) patients had MI, 6 (9.4%%) patients had AIS, and one (1.5%) patient a thrombosis of portal vein. TEE patients exhibited a diffuse profile: older, high levels of D-dimer protein and a tendency of lower levels of prothrombin. The multivariate regression models, confirmed the association between in-hospital death and age (odds ratio [OR] 1.12 [95% CI 1.10-1.14], p<0.001), diabetes (OR 1.49 [95% CI 1.04-2.13], p = 0.029), chronic obstructive pulmonary disease (OR 1.61 [95% CI 1.03-2.53], p = 0.039), ICU care (OR 9.39 [95% CI 5.69-15.51], p<0.001), and TTE (OR 2.24 [95% CI 1.17-4.29], p = 0.015). CONCLUSIONS: Special attention is needed among hospitalized COVID-19 patients with TTE and other comorbidities as they have an increased risk of in-hospital death.


Subject(s)
COVID-19/mortality , COVID-19/pathology , Thromboembolism/mortality , Thromboembolism/virology , Aged , COVID-19/epidemiology , COVID-19/virology , Cross-Sectional Studies , Female , Hospital Mortality , Hospitalization/statistics & numerical data , Humans , Male , Prognosis , Risk Factors , SARS-CoV-2/isolation & purification , Spain/epidemiology , Survival Rate , Thromboembolism/epidemiology
20.
Eur J Epidemiol ; 36(6): 619-627, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1258229

ABSTRACT

The aim of this study was to evaluate the impact of the COVID-19 pandemic lockdown on acute myocardial infarction (AMI) care, and to identify underlying stressors in the German model region for complete AMI registration. The analysis was based on data from the population-based KORA Myocardial Infarction Registry located in the region of Augsburg, Germany. All cases of AMI (n = 210) admitted to one of four hospitals in the city of Augsburg or the county of Augsburg from February 10th, 2020, to May 19, 2020, were included. Patients were divided into three groups, namely pre-lockdown, strict lockdown, and attenuated lockdown period. An additional survey was conducted asking the patients for stress and fears in the 4 weeks prior to their AMI. The AMI rate declined by 44% in the strict lockdown period; in the attenuated lockdown period the rate was 17% lower compared to the pre-lockdown period. The downward trend in AMI rates during lockdown was seen in STEMI and NSTEMI patients, and independent of sex and age. The door-to-device time decreased by 70-80% in the lockdown-periods. In the time prior to the infarction, patients felt stressed mainly due to fear of infection with Sars-CoV-2 and less because of the restrictions and consequences of the lockdown. A strict lockdown due to the Covid-19 pandemic had a marked impact on AMI care even in a non-hot-spot region with relatively few cases of COVID-19. Fear of infection with the virus is presumably the main reason for the drop in hospitalizations due to AMI.


Subject(s)
COVID-19/prevention & control , Myocardial Infarction/therapy , Physical Distancing , Age Factors , Aged , Female , Germany , Humans , Male , Middle Aged , Pandemics , Prospective Studies , Quarantine , Registries , SARS-CoV-2 , Sex Factors , Time Factors
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