Treatment of ST-Segment Elevation Myocardial Infarction During COVID-19 Pandemic

Area of Science:

• Cardiology
• Infectious Diseases
• Critical Care Medicine

Background:

• The global rise in coronavirus-induced disease-2019 (COVID-19) cases presents significant challenges in managing acute cardiovascular emergencies.
• ST-segment elevation myocardial infarction (STEMI) management is particularly complex during this pandemic.

Purpose of the Study:

• To review and compare the risks and benefits of primary percutaneous coronary intervention (PCI) versus thrombolysis for STEMI in the context of COVID-19.
• To determine the optimal reperfusion strategy for STEMI patients during the pandemic.

Main Methods:

• This is a review article.
• The authors analyzed existing literature on primary PCI and thrombolysis for STEMI, focusing on patient outcomes and resource utilization.
• Specific considerations for STEMI management during active COVID-19 infection were evaluated.

Main Results:

• Thrombolysis, while an option, has numerous contraindications, potentially leading to suboptimal outcomes and increased resource use.
• Active COVID-19 infection can lead to non-obstructed coronary arteries on angiography in a significant proportion of STEMI cases.
• Primary PCI demonstrates a favorable risk-benefit profile in this setting.

Conclusions:

• Primary PCI should be the preferred reperfusion strategy for STEMI patients, especially during the COVID-19 pandemic.
• The high likelihood of non-obstructed arteries in COVID-19 patients undergoing angiography supports the selection of primary PCI.
• Careful patient selection and resource management are crucial for STEMI treatment during public health crises.