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Case Selection During the COVID-19 Pandemic: Who Should Go to the Cardiac Catheterization Laboratory?
Evangelia Vemmou1, Ilias Nikolakopoulos1, Emmanouil S Brilakis1
1Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 920 E 28th Street #300, Minneapolis, MN 55407 USA.
Insights
The COVID-19 pandemic significantly reduced cardiac catheterization laboratory (CCL) use for ST-elevation myocardial infarction (STEMI) care, increasing morbidity and mortality. Balancing patient needs with healthcare worker safety remains a critical challenge.
Area of Science:
- Cardiology
- Infectious Disease Epidemiology
- Public Health
Background:
- The COVID-19 pandemic necessitated restructuring of cardiovascular services globally.
- This restructuring aimed to preserve hospital resources like beds and personal protective equipment.
- Unintended consequences significantly impacted healthcare delivery and patient outcomes.
Purpose of the Study:
- To review evidence and recommendations for selecting ST-elevation myocardial infarction (STEMI) cases for cardiac catheterization laboratory (CCL) procedures during the COVID-19 pandemic.
- To emphasize management strategies for STEMI during the pandemic.
- To provide guidance on balancing patient care with infection risk.
Main Methods:
- Systematic review of available evidence.
- Analysis of recommendations from consensus documents.
- Synthesis of findings on case selection and management.
Main Results:
- A significant reduction in CCL activations for STEMI was observed in the US (38%).
- Utilization of invasive angiography decreased by 34%, and primary percutaneous coronary intervention (PPCI) by 18%.
- Door-to-balloon times increased by 19%, coinciding with more out-of-hospital cardiac arrests and late STEMI presentations. A shift to pharmacological reperfusion in Asia led to increased morbidity and mortality.
Conclusions:
- COVID-19 negatively impacted STEMI care, particularly timely mechanical reperfusion, leading to increased morbidity and mortality.
- Balancing optimal STEMI care with infection risk for healthcare workers is a significant challenge.
- Consensus recommendations offer valuable guidance for navigating these complexities.
Purpose Of Review:
To summarize the best available evidence and recommendations regarding case selection for cardiac catheterization laboratory (CCL) during the coronavirus disease 2019 (COVID-19) pandemic with emphasis on ST segment elevation myocardial infarction (STEMI) management.
Recent Findings:
The restructuring of cardiovascular services to preserve hospital beds and personal protective equipment during the COVID-19 pandemic had a profound effect on healthcare delivery around the world with unintended consequences. In the United States, a significant 38% reduction in CCL activations for STEMI was noted in the early phase of the pandemic. Similarly, a 34% decline in utilization of invasive angiography, an 18% reduction in primary percutaneous coronary intervention (PPCI), and a 19% increase in door-to-balloon (D2B) times were also observed. These trends coincided with a significant increase in out-of-hospital cardiac arrests and late MI presentations. A shift to pharmacological reperfusion has been advocated in Asia, which resulted in increased morbidity and mortality.
Summary:
COVID-19 has negatively affected many aspects of STEMI care, including timely access to mechanical reperfusion, which has resulted in increased morbidity and mortality. Balancing optimal STEMI care with the risk of infection to healthcare workers during the pandemic is challenging. Recommendations provided by consensus documents are a helpful guidance.
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