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Management of acute coronary syndromes during the COVID-19 outbreak in Lombardy: The "macro-hub" experience

Stefano Carugo1, Marco Ferlini2, Diego Castini1

  • 1Cardiology Department, University of Milan, ASST Santi Paolo e Carlo, Milano, Italy.

International Journal of Cardiology. Heart & Vasculature
|November 11, 2020
PubMed

Insights

The Lombardy region

Area of Science:

  • Cardiology
  • Public Health
  • Infectious Diseases

Background:

  • COVID-19 pandemic necessitated restructuring of emergency healthcare networks.
  • Lombardy's healthcare authorities reorganized the regional network for time-dependent emergencies.
  • 13 Macro-Hubs were established to manage acute coronary syndromes (ACS) effectively.

Purpose of the Study:

  • To evaluate the impact of the restructured ACS network during the COVID-19 outbreak.
  • To assess the management and outcomes of patients with ACS in Lombardy.
  • To analyze the outcomes of ACS patients co-infected with SARS-CoV-2.

Main Methods:

  • Multicenter observational study.
  • Inclusion of 953 patients with acute coronary syndromes (ACS).
  • Analysis of data including ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) cases, coronary angiography times, SARS-CoV-2 infection rates, and in-hospital outcomes.

Main Results:

  • 98% of patients underwent coronary angiography with median times of 79 minutes for STEMI and 1262 minutes for NSTEMI.
  • 11.2% of patients tested positive for SARS-CoV-2, predominantly STEMI cases (74.8%).
  • Patients with COVID-19 showed shorter cath-lab times but higher in-hospital mortality (32% vs 6%) and cardiogenic shock rates (16.8% vs 6.7%).

Conclusions:

  • The redefined ACS network in Lombardy facilitated timely management during the COVID-19 pandemic.
  • The network successfully reserved intensive care beds for pandemic response.
  • ACS patients with COVID-19 experienced worse outcomes, especially STEMI patients.
Abstract

Keywords:
Acute coronary syndromesCOVID-19Macro-hubsNSTEMISTEMISars-CoV2

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