Managing MI during Covid 19 pandemic- SCAI, ACC, ACEP consensus statement

WASHINGTON -American College of Cardiology (ACC), Society for Cardiovascular Angiography and Interventions (SCAI), and American College of Emergency Physicians (ACEP) have released a consensus statement outlining recommendations for a systematic approach for the care of patients with an acute myocardial infarction (AMI) during the coronavirus disease-2019 (COVID-19) pandemic. The document has been jointly published in Catheterization and Cardiovascular Interventions, the official journal of SCAI, and the Journal of the American College of Cardiology.

According to recent studies, cardiovascular disease patients who develop COVID-19 have a higher risk of mortality. However, many patients in need of care for the management of various heart diseases may not be infected with this coronavirus.

Although there are challenges, the statement recommends "[informing] the public that we can minimize exposure to the coronavirus so they can continue to call the Emergency Medical System (EMS) for acute ischemic heart disease symptoms and therefore get the appropriate level of cardiac care that their presentation warrants."

The statement also recommends targeting the use of primary PCI or fibrinolysis (at referral or non-PCI capable hospitals) in patients with STEMI, aiming to avoid reperfusion therapy for those with other causes of ST-segment elevation on the electrocardiogram, and maximizing the safety of the health care team through the appropriate masking of patients and the use of PPE.

The document identifies several challenges in providing recommendations for AMI care during the COVID-19 epidemic: cardiovascular manifestations in the COVID-19 patient are complex and variable, the prevalence of COVID-19 in U.S. populations remains unknown, and personal protection equipment (PPE) is not uniformly available.

"During the COVID-19 pandemic we wanted to ensure that patients continue to benefit from the tremendous advances made in the care of patients with cardiovascular disease over the past three decades," said Ehtisham Mahmud, MD, FSCAI, SCAI president and lead author of the writing group. "Primary percutaneous coronary intervention (PCI) is the standard of care for STEMI patients, and in this document, we outline an approach to providing that therapy at PCI-capable hospitals while also ensuring health care worker safety with appropriate PPE."

The writing group recommends informing the public that exposure to the virus can be minimized, that that patients continue to call the Emergency Medical System when presenting with acute ischemic heart disease symptoms, with the intention of primary PCI when indicated. Fibrinolysis at referral hospitals (non-PCI capable) is appropriate with a plan of care for rescue or pharmacoinvasive PCI. The document also provides strategies for maximizing the safety of medical personnel with appropriate use of personal protection equipment and masking patients.

For further reference log on to:

http://dx.doi.org/10.1002/ccd.28946