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Management of Acute Myocardial Infarction During COVID-19 Pandemic Published in Journal of the Society for Cardiac Angiography & Interventions

Groundbreaking Analysis Endorsed and Supported by Cardiovascular Societies

4/21/2020

The Christ Hospital Health Network is honoring its commitment to provide the best heart care in Greater Cincinnati, announcing today the publication of a consensus on management of Acute Myocardial Infarction during the COVID-19 pandemic in real-time analysis published today in the Journal of the Society for Cardiac Angiography & Interventions.

This approach Indicates patients with cardiovascular disease who develop COVID-19 have a higher risk of mortality, however many patients who need cardiovascular care for ischemic heart disease, peripheral vascular or structural heart disease may not be infected with COVID-19. Given that the United States now has the highest number of documented COVID-19 patients in the world, and patients will present with this disease over at least the next 12-18 months, recommendations are put forth for a systematic approach in the care of patients with an acute myocardial infarction (AMI) during the COVID19 pandemic that includes informing the public how we minimize exposure to the coronavirus so they may call on the Emergency Medical System (EMS) for acute ischemic heart disease symptoms for appropriate cardiac care; targeting the use of primary percutaneous coronary intervention (PCI) or fibrinolysis in patients with ST-elevation myocardial infarction (STEMI) and aim to avoid reperfusion therapy for those with other causes of ST-segment elevation on the electrocardiogram (ECG); and maximizing the safety of medical personnel by appropriate masking of patients and the use of personal protection equipment (PPE).

The study focuses on effective preparations for the care of patients to ensure the overall patient population will continue to benefit from the tremendous advancements in cardiovascular care in recent decades and includes an imperative that health care workers use appropriate PPE for all invasive procedures during this pandemic, that new rapid COVID-19 testing be expeditiously disseminated to all hospitals involved in the care of patients with AMI, and each regional STEMI care network needs to revise their suggested algorithm for its local environment and ensure that EMS and referral hospital teams are facile with a balanced and standardized approach towards STEMI care during the COVID-19 pandemic.

“In these situations, timing is key and our hospitals across the country must follow careful procedures to keep patients safe from COVID-19 exposure, while providing life-saving treatments for other cardiovascular conditions,” said Timothy Henry, MD, interventional cardiologist Lindner Family Distinguished Chair in Clinical Research and Medical Director of The Carl and Edyth Lindner Center for Research at The Christ Hospital.

During the COVID-19 pandemic, primary PCI remains the standard of care for STEMI patients at PCI capable hospitals when it can be provided in a timely fashion, with an expert team outfitted with PPE in a dedicated CCL room. A fibrinolysis-based strategy may be entertained at non-PCI capable referral hospitals or in specific situations where primary PCI cannot be executed or is not deemed the best option. Clinicians should recognize that patients with COVID-19 are inherently complex: a broad differential diagnosis for ST elevations (including COVID-associated myocarditis) should be considered in the ED prior to choosing a reperfusion strategy. In the absence of hemodynamic instability or ongoing ischemic symptoms, NSTEMI patients who are COVID-19 positive or probable are optimally managed with an initial medical stabilization strategy.

“It is essential to inform the public of all steps taken to minimize their exposure to the coronavirus so they may continue to call on Emergency Medical System (EMS) for acute ischemic heart disease symptoms and receive the appropriate level of cardiac care they desperately need,” said Dr, Henry. “While the COVID-19 pandemic continues to impact routines for people around the region and nation, we remain committed to our mission in leading innovating cardiovascular research and education that is at the heart of The Christ Hospital’s, Greater Cincinnati’s Heart Hospital, mission.”

About The Christ Hospital Health Network: The Christ Hospital Health Network is an acute care hospital located in Mt. Auburn with six ambulatory centers and dozens of offices conveniently located throughout the region. More than 1,200 talented physicians and 6,500 dedicated employees support the Network. Its mission is to improve the health of the community and to create patient value by providing exceptional outcomes, the finest experiences, all in an affordable way. The Network has been recognized by Forbes Magazine as the 24th best large employer in the nation in the magazine’s “America’s 500 Best Large Employers” listing and by National Consumer Research as the region’s “Most Preferred Hospital.” The Network is dedicated to transforming care by delivering integrated, personalized healthcare through its comprehensive, multi-specialty physician network. The Christ Hospital is among only eight percent of hospitals in the nation to be awarded “Magnet” recognition for nursing excellence and among the top five percent of hospitals in the country for patient satisfaction. For more than 125 years, The Christ Hospital has provided compassionate care to those it serves.