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Castro-Varela A, Martinez-Magallanes DM, Reyes-Chavez MF, Gonzalez-Rayas JM, Paredes-Vazquez JG, Vazquez-Garza E, Castillo-Perez M, Flores-Sayavedra YZ, Martinez A, Ramos Cazares RE, Guajardo J, Lopez-de la Garza H, Salinas-Casanova JA, Betancourt H, Molina-Rodriguez AM, Panneflek J, Fabiani MA, Jerjes-Sanchez C. Risk Factors, Clinical Presentation, Therapeutic Trends, and Outcomes in Arterial Thrombosis Complicating Unvaccinated COVID-19 Patients: A Systematic Review. Angiology 2024; 75:625-634. [PMID: 37005343 PMCID: PMC10083125 DOI: 10.1177/00033197231167055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Data on characteristics and outcomes of coronavirus (COVID)-19 patients complicated with arterial thrombosis (AT) are scarce. Therefore, we carried out a systematic review (PRISMA, PROSPERO statements; PubMed, Scopus, and Web of Science) to identify risk factors, clinical presentation, treatment, and outcomes. We included publications from December 2019 to October 2020. Groups: (a) ischemic stroke, (b) thrombotic storm, (c) peripheral vascular thrombosis, (d) myocardial infarction, and (e) left cardiac thrombus or in-transit thrombus (venous system thrombus floating or attaching to the right heart). We considered 131 studies. The most frequent cardiovascular risk factors were: hypertension, diabetes, and dyslipidemia. A high proportion presented with asymptomatic, mild, or moderate COVID-19 (n = 91, 41.4%). We identified a high percentage of isolated ischemic stroke and thrombotic storm. Groups with higher mortality rate: intracardiac thrombus (1/2, 50.0%), thrombotic storm (18/49, 36.7%), and ischemic stroke (48/131, 36.6%). A small number received thromboprophylaxis. Most patients received antithrombotic treatment. The most frequent bleeding complication was intracranial hemorrhage, primarily with isolated stroke. Overall mortality was 33.6% (74/220). Despite a wide range of COVID-19 severity, a high proportion had AT as a complication of non-severe disease. AT can affect different vascular territories; mortality is associated with stroke, intensive care unit stay, and severe COVID-19.
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Affiliation(s)
- Alejandra Castro-Varela
- Tecnologico de
Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey,
Nuevo Leon, Mexico
| | | | - Maria Fernanda Reyes-Chavez
- Tecnologico de
Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey,
Nuevo Leon, Mexico
- Unidad Experimental de Terapias
Avanzadas del Hospital Zambrano Hellion, TecSalud, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | | | - Jose Gildardo Paredes-Vazquez
- Tecnologico de
Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey,
Nuevo Leon, Mexico
- Instituto de Cardiologia y Medicina
Vascular, TecSalud, Escuela de Medicina y Ciencias de la Salud,
Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Eduardo Vazquez-Garza
- Tecnologico de
Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey,
Nuevo Leon, Mexico
- Unidad Experimental de Terapias
Avanzadas del Hospital Zambrano Hellion, TecSalud, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Mauricio Castillo-Perez
- Tecnologico de
Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey,
Nuevo Leon, Mexico
| | | | - Arturo Martinez
- Tecnologico de
Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey,
Nuevo Leon, Mexico
| | - Ray Erick Ramos Cazares
- Tecnologico de
Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey,
Nuevo Leon, Mexico
| | - Jaime Guajardo
- Tecnologico de
Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey,
Nuevo Leon, Mexico
| | - Hector Lopez-de la Garza
- Tecnologico de
Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey,
Nuevo Leon, Mexico
| | | | - Hector Betancourt
- Tecnologico de
Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey,
Nuevo Leon, Mexico
| | | | - Jathniel Panneflek
- Unidad Experimental de Terapias
Avanzadas del Hospital Zambrano Hellion, TecSalud, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Mario Alejandro Fabiani
- Instituto de Cardiologia y Medicina
Vascular, TecSalud, Escuela de Medicina y Ciencias de la Salud,
Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Carlos Jerjes-Sanchez
- Tecnologico de
Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey,
Nuevo Leon, Mexico
- Unidad Experimental de Terapias
Avanzadas del Hospital Zambrano Hellion, TecSalud, San Pedro Garza Garcia, Nuevo Leon, Mexico
- Instituto de Cardiologia y Medicina
Vascular, TecSalud, Escuela de Medicina y Ciencias de la Salud,
Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
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Dehghani P, Singh J, Mancini GBJ, Stanberry L, Bergstedt S, Madan M, Benziger CP, Ghasemzadeh N, Bortnick A, Kankaria R, Grines CL, Nayak K, Yildiz M, Alraies MC, Bagai A, Patel RAG, Amlani S, Case BC, Waksman R, Shavadia JS, Stone JH, Acharya D, Javed N, Bagur R, Garberich R, Garcia S, Henry TD. Angiographic characteristics of patients with STEMI and COVID-19: Insights from NACMI registry. Am Heart J 2024; 271:112-122. [PMID: 38395293 DOI: 10.1016/j.ahj.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND To date, there has been no independent core lab angiographic analysis of patients with COVID-19 and STEMI. The study characterized the angiographic parameters of patients with COVID-19 and STEMI. METHODS Angiograms of patients with COVID-19 and STEMI from the North American COVID-19 Myocardial Infarction (NACMI) Registry were sent to a Core Laboratory in Vancouver, Canada. Culprit lesion(s), Thrombolysis In Myocardial Infarction (TIMI) flow, Thrombus Grade Burden (TGB), and percutaneous coronary intervention (PCI) outcome were assessed. RESULTS From 234 patients, 74% had one culprit lesion, 14% had multiple culprits and 12% had no culprit identified. Multivessel thrombotic disease and multivessel CAD were found in 27% and 53% of patients, respectively. Stent thrombosis accounted for 12% of the presentations and occurred in 55% of patients with previous coronary stents. Of the 182 who underwent PCI, 60 (33%) had unsuccessful PCI due to post-PCI TIMI flow <3 (43/60), residual high thrombus burden (41/60) and/or thrombus related complications (27/60). In-hospital mortality for successful, partially successful, and unsuccessful PCI was 14%, 13%, and 27%, respectively. Unsuccessful PCI was associated with increased risk of in-hospital mortality (risk ratio [RR] 1.96; 95% CI: 1.05-3.66, P = .03); in the adjusted model this estimate was attenuated (RR: 1.24; 95% CI: 0.65-2.34, P = .51). CONCLUSION In patients with COVID-19 and STEMI, thrombus burden was pervasive with notable rates of multivessel thrombotic disease and stent thrombosis. Post-PCI, persistent thrombus and sub-optimal TIMI 3 flow rates led to one-third of the PCI's being unsuccessful, which decreased over time but remained an important predictor of in-hospital mortality.
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Affiliation(s)
- Payam Dehghani
- Prairie Vascular Research, Regina, Saskatchewan, Canada.
| | - Jyotpal Singh
- Prairie Vascular Research, Regina, Saskatchewan, Canada
| | - G B John Mancini
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Mina Madan
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Anna Bortnick
- Albert Einstein College of Medicine and Montefiore Health System, Bronx, NY
| | - Rohan Kankaria
- Albert Einstein College of Medicine and Montefiore Health System, Bronx, NY
| | - Cindy L Grines
- Northside Hospital Cardiovascular Institute, Atlanta, GA
| | | | | | - M Chadi Alraies
- Detroit Medical Center, Harper University Hospital, Detroit, MI
| | - Akshay Bagai
- Terrence Donnelly Heart Center, St Michael's Hospital, Unity Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rajan A G Patel
- Ochsner Medical Center, University of Queensland Ochsner Clinical School, New Orleans, LA
| | - Shy Amlani
- William Osler Health System, Ontario, Canada
| | - Brian C Case
- MedStar Heart & Vascular Institute, Washington, DC
| | - Ron Waksman
- MedStar Heart & Vascular Institute, Washington, DC
| | | | | | | | - Nosheen Javed
- Charlton Memorial Hospital, Southcoast Health Fall River, MA
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Shavadia JS, Stanberry L, Singh J, Thao KR, Ghasemzadeh N, Mercado N, Nayak KR, Alraies MC, Bagur R, Saw J, Bagai A, Bainey KR, Madan M, Amlani S, Garberich R, Grines CL, Garcia S, Henry TD, Dehghani P. Comparative Analysis of Patients With STEMI and COVID-19 Between Canada and the United States. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023:100970. [PMID: 37363317 PMCID: PMC10284462 DOI: 10.1016/j.jscai.2023.100970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 06/28/2023]
Abstract
Background Important health care differences exist between the United States (US) and Canada, which may have been exacerbated during the pandemic. We compared clinical characteristics, treatment strategies, and clinical outcomes of patients with ST-segment elevation myocardial infarction (STEMI) and COVID-19 (STEMI-COVID) treated in the US and Canada. Methods The North American COVID-19 Myocardial Infarction registry is a prospective, investigator-initiated study enrolling patients with STEMI with confirmed or suspected COVID-19 in the US and Canada. The primary end point was in-hospital mortality. Additionally, we explored associations between vaccination and clinical outcomes. Results Of 853 patients with STEMI-COVID, 112 (13%) were enrolled in Canada, and compared with the US, patients in Canada were more likely to present with chest pain and less likely to have a history of heart failure, stroke/transient ischemic attack, pulmonary infiltrates or renal failure. In both countries, the primary percutaneous coronary intervention was the dominant reperfusion strategy, with no difference in door-to-balloon times; fibrinolysis was used less frequently in the US than in Canada. The adjusted in-hospital mortality was not different between the 2 countries (relative risk [RR], 1.0; 95% CI, 0.46-2.72; P = 1.0). However, the risk of in-hospital mortality was significantly higher in unvaccinated compared with vaccinated patients with STEMI-COVID (RR, 4.7; 95% CI, 1.7-11.53; P = .015). Conclusions Notable differences in morbidities and reperfusion strategies were evident between patients with STEMI-COVID in the US compared with Canada. No differences were noted for in-hospital mortality. Vaccination, regardless of region, appeared to associate with a lower risk of in-hospital mortality strongly.
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Affiliation(s)
- Jay S Shavadia
- Division of Cardiology, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Jyotpal Singh
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada
| | | | - Nima Ghasemzadeh
- Georgia Heart Institute, Northeast Georgia Medical Center, Gainesville, Georgia
| | | | - Keshav R Nayak
- Department of Cardiology, Scripps Mercy Hospital, San Diego, California
| | | | - Rodrigo Bagur
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Jacqueline Saw
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Kevin R Bainey
- University of Alberta, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Mina Madan
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Shy Amlani
- William Osler Health System, Brampton, Ontario, Canada
| | - Ross Garberich
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | | | - Santiago Garcia
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio
| | - Payam Dehghani
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada
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Guddeti RR, Sanina C, Jauhar R, Henry TD, Dehghani P, Garberich R, Schmidt CW, Nayak KR, Shavadia JS, Bagai A, Alraies C, Mehra A, Bagur R, Grines C, Singh A, Patel RA, Htun WW, Ghasemzadeh N, Davidson L, Acharya D, Kabour A, Hafiz AM, Amlani S, Wasserman HS, Smith T, Kapur NK, Garcia S. Mechanical Circulatory Support in Patients With COVID-19 Presenting With Myocardial Infarction. Am J Cardiol 2023; 187:76-83. [PMID: 36459751 PMCID: PMC9706494 DOI: 10.1016/j.amjcard.2022.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/26/2022] [Accepted: 09/30/2022] [Indexed: 11/30/2022]
Abstract
ST-segment elevation myocardial infarction (STEMI) complicating COVID-19 is associated with an increased risk of cardiogenic shock and mortality. However, little is known about the frequency of use and clinical impact of mechanical circulatory support (MCS) in these patients. We sought to define patterns of MCS utilization, patient characteristics, and outcomes in patients with COVID-19 with STEMI. The NACMI (North American COVID-19 Myocardial Infarction) is an ongoing prospective, observational registry of patients with COVID-19 positive (COVID-19+) with STEMI with a contemporary control group of persons under investigation who subsequently tested negative for COVID-19 (COVID-19-). We compared the baseline characteristics and in-hospital outcomes of COVID-19+ and patients with COVID-19- according to the use of MCS. The primary outcome was a composite of in-hospital mortality, stroke, recurrent MI, and repeat unplanned revascularization. A total of 1,379 patients (586 COVID-19+ and 793 COVID-19-) enrolled in the NACMI registry between January 2020 and November 2021 were included in this analysis; overall, MCS use was 12.3% (12.1% [n = 71] COVID-19+/MCS positive [MCS+] vs 12.4% [n = 98] COVID-19-/MCS+). Baseline characteristics were similar between the 2 groups. The use of percutaneous coronary intervention was similar between the groups (84% vs 78%; p = 0.404). Intra-aortic balloon pump was the most frequently used MCS device in both groups (53% in COVID-19+/MCS+ and 75% in COVID-19-/MCS+). The primary outcome was significantly higher in COVID-19+/MCS+ patients (60% vs 30%; p = 0.001) because of very high in-hospital mortality (59% vs 28%; p = 0.001). In conclusion, patients with COVID-19+ with STEMI requiring MCS have very high in-hospital mortality, likely related to the significantly higher pulmonary involvement compared with patients with COVID-19- with STEMI requiring MCS.
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Affiliation(s)
- Raviteja R. Guddeti
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Cristina Sanina
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Rajiv Jauhar
- North Shore University Hospital, Manhasset, New York
| | - Timothy D. Henry
- The Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio
| | | | - Ross Garberich
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | - Keshav R. Nayak
- Department of Cardiology, Scripps Mercy Hospital, San Diego, California
| | - Jay S. Shavadia
- Royal University Hospital, University of Saskatchewan Saskatoon, Saskatchewan, Canada
| | | | | | - Aditya Mehra
- Jersey Shore University Medical Center, Neptune, New Jersey
| | - Rodrigo Bagur
- London Health Sciences Centre, London, Ontario, Canada
| | - Cindy Grines
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia
| | - Avneet Singh
- North Shore University Hospital, Manhasset, New York
| | - Rajan A.G. Patel
- Ochsner Health, University of Queensland Ochsner Clinical School, New Orleans, Louisiana
| | | | | | | | - Deepak Acharya
- University of Arizona Sarver Heart Center, Tuczon, Arizona
| | | | - Abdul Moiz Hafiz
- Southern Illinois University School of Medicine. Springfiled, Illinois
| | - Shy Amlani
- William Osler Health System, Ontario, Canada
| | | | - Timothy Smith
- The Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio
| | | | - Santiago Garcia
- The Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio.
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5
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Dehghani P, Schmidt CW, Garcia S, Okeson B, Grines CL, Singh A, Patel RAG, Wiley J, Htun WW, Nayak KR, Alraies MC, Ghasemzadeh N, Davidson LJ, Acharya D, Stone J, Alyousef T, Case BC, Dai X, Hafiz AM, Madan M, Jaffer FA, Shavadia JS, Garberich R, Bagai A, Singh J, Aronow HD, Mercado N, Henry TD. North American COVID-19 Myocardial Infarction (NACMI) Risk Score for Prediction of In-Hospital Mortality. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100404. [PMID: 35845345 PMCID: PMC9270689 DOI: 10.1016/j.jscai.2022.100404] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Abstract
Background In-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) is higher in those with COVID-19 than in those without COVID-19. The factors that predispose to this mortality rate and their relative contribution are poorly understood. This study developed a risk score inclusive of clinical variables to predict in-hospital mortality in patients with COVID-19 and STEMI. Methods Baseline demographic, clinical, and procedural data from patients in the North American COVID-19 Myocardial Infarction registry were extracted. Univariable logistic regression was performed using candidate predictor variables, and multivariable logistic regression was performed using backward stepwise selection to identify independent predictors of in-hospital mortality. Independent predictors were assigned a weighted integer, with the sum of the integers yielding the total risk score for each patient. Results In-hospital mortality occurred in 118 of 425 (28%) patients. Eight variables present at the time of STEMI diagnosis (respiratory rate of >35 breaths/min, cardiogenic shock, oxygen saturation of <93%, age of >55 years, infiltrates on chest x-ray, kidney disease, diabetes, and dyspnea) were assigned a weighted integer. In-hospital mortality increased exponentially with increasing integer risk score (Cochran-Armitage χ2, P < .001), and the model demonstrated good discriminative power (c-statistic = 0.81) and calibration (Hosmer-Lemeshow, P = .40). The increasing risk score was strongly associated with in-hospital mortality (3.6%-60% mortality for low-risk and very high–risk score categories, respectively). Conclusions The risk of in-hospital mortality in patients with COVID-19 and STEMI can be accurately predicted and discriminated using readily available clinical information.
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Affiliation(s)
- Payam Dehghani
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada
| | | | - Santiago Garcia
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Brynn Okeson
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | | | - Avneet Singh
- Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, New York
| | | | - Jose Wiley
- Albert Einstein College of Medicine, Montefiore Health System, New York, New York
| | | | - Keshav R Nayak
- Department of Cardiology, Scripps Mercy Hospital, San Diego, California
| | | | | | - Laura J Davidson
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Deepak Acharya
- University of Arizona Sarver Heart Center, Tucson, Arizona
| | - Jay Stone
- Community Medical Center (RWJ Barnabas Health), Toms River, New Jersey
| | - Tareq Alyousef
- Cook County Health and Hospitals System, Chicago, Illinois
| | - Brian C Case
- MedStar Washington Hospital Center, Washington, District of Columbia
| | - Xuming Dai
- NewYork-Presbyterian Queens, Flushing, New York
| | - Abdul Moiz Hafiz
- Southern Illinois University School of Medicine, Springfield, Illinois
| | - Mina Madan
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Jay S Shavadia
- Royal University Hospital (Saskatchewan Health), University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ross Garberich
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Akshay Bagai
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jyotpal Singh
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada
| | - Herbert D Aronow
- Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, Rhode Island
| | | | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio
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Quesada O, Van Hon L, Yildiz M, Madan M, Sanina C, Davidson L, Htun WW, Saw J, Garcia S, Dehghani P, Stanberry L, Bortnick A, Henry TD, Grines CL, Benziger C. Sex Differences in Clinical Characteristics, Management Strategies, and Outcomes of STEMI With COVID-19: NACMI Registry. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100360. [PMID: 35812987 PMCID: PMC9117757 DOI: 10.1016/j.jscai.2022.100360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 12/11/2022]
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Batenova G, Dedov E, Pivin M, Nikitin I, Ettinger O, Smail Y, Ygiyeva D, Pivina L. Coronary Heart Disease and Coronavirus Disease 2019: Pathogenesis, Epidemiology, Association with Myocardial Revascularization. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Coronavirus disease 2019 (COVID-19) causes a hypercoagulable state with a high incidence of thrombotic complications. Patients with a history of myocardial revascularization have more severe complications due to COVID-19. Coronary stent thrombosis has become significantly more common during the COVID-19 pandemic.
AIM: The aim of our study is to analyze scientific information on the risks of stent thrombosis in patients who underwent COVID-19.
METHODS: A search was made for scientific publications in evidence-based medicine databases and web resources: PubMed, MEDLINE, UpToDate, TripDatabase, ResearchGate, and Google Scholar. Inclusion criteria were: (1) Observational studies or case series involving patients with a confirmed diagnosis of COVID-19 and myocardial infarction requiring myocardial revascularization; (2) the division of the population into survivors and non-survivors; and (3) data on the presence of the previous myocardial revascularization. Exclusion criteria: Case description and editorials/bulletins. In all articles selected for further analysis, 49 sources were considered that met the inclusion criteria and excluded duplication or repetition of information.
RESULTS: Coronavirus infection has contributed to the change in the course of myocardial infarction in patients undergoing myocardial revascularization. The incidence of stent thrombosis has a positive correlation with the severity of the coronavirus infection. The previous myocardial revascularization procedures significantly increase the risk of mortality in patients with coronavirus infection. This is especially actual for elderly patients.
CONCLUSION: One of the most vulnerable groups is elderly patients who have undergone myocardial revascularization after myocardial infarction in the past and have concomitant diseases. An analysis of scientific publications has shown that further larger-scale clinical studies are needed to confirm the hypothesis about the negative impact of coronavirus infection on stent thrombosis in patients who have undergone COVID-19.
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Abstract
Purpose of this Review We discuss the role of observational studies and cardiac registries during the COVID-19 pandemic. We focus on published cardiac registries and highlight contributions to the field that have had clinical implications. Recent Findings We included observational studies of COVID-19 patients published in peer-reviewed medical journals with defined inclusion and exclusion criteria, defined study design, and primary outcomes. A PubMed and MEDLINE literature review results in 437 articles, of which 52 include patients with COVID-19 with cardiac endpoints. From July 2020 to December 2021, the average time from last data collected to publication was 8.9 ± 4.1 months, with an increasing trend over time (R = 0.9444, p < 0.0001). Of the 52 articles that met our inclusion criteria, we summarize main findings of 4 manuscripts on stroke, 14 on acute coronary syndrome, 4 on cardiac arrest, 7 on heart failure, 7 on venous thromboembolism, 5 on dysrhythmia, and 11 on different populations at risk for cardiovascular. Summary Registries are cost effective, not disruptive to essential health services, and can be rapidly disseminated with short intervals between last data point collected and publication. In less than 2 years, cardiac registries have filled important gaps in knowledge and informed the care of COVID-19 patients with cardiovascular conditions. Supplementary Information The online version contains supplementary material available at 10.1007/s11886-022-01686-5.
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Garcia S, Dehghani P, Stanberry L, Grines C, Patel RAG, Nayak KR, Singh A, Htun WW, Kabour A, Ghasemzadeh N, Sanina C, Aragon J, Alraies C, Benziger C, Okeson B, Garberich R, Welt FG, Davidson L, Hafiz AM, Acharya D, Stone J, Mehra A, Amlani S, Mahmud E, Giri J, Yildiz M, Henry TD. Trends in Clinical Characteristics, Management Strategies and Outcomes of STEMI Patients with COVID-19. J Am Coll Cardiol 2022; 79:2236-2244. [PMID: 35390486 PMCID: PMC8978699 DOI: 10.1016/j.jacc.2022.03.345] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 11/17/2022]
Abstract
Background We previously reported high in-hospital mortality for ST-segment elevation myocardial infarction (STEMI) patients with COVID-19 treated in the early phase of the pandemic. Objectives The purpose of this study was to describe trends of COVID-19 patients with STEMI during the course of the pandemic. Methods The NACMI (North American COVID-19 STEMI) registry is a prospective, investigator-initiated, multicenter, observational registry of hospitalized STEMI patients with confirmed or suspected COVID-19 infection in North America. We compared trends in clinical characteristics, management, and outcomes of patients treated in the first year of the pandemic (January 2020 to December 2020) vs those treated in the second year (January 2021 to December 2021). Results A total of 586 COVID-19–positive patients with STEMI were included in the present analysis; 227 treated in Y2020 and 359 treated in Y2021. Patients’ characteristics changed over time. Relative to Y2020, the proportion of Caucasian patients was higher (58% vs 39%; P < 0.001), patients presented more frequently with typical ischemic symptoms (59% vs 51%; P = 0.04), and patients were less likely to have shock pre-PCI (13% vs 18%; P = 0.07) or pulmonary manifestations (33% vs. 47%; P = 0.001) in Y2021. In-hospital mortality decreased from 33% (Y2020) to 23% (Y2021) (P = 0.008). In Y2021, none of the 22 vaccinated patients expired in hospital, whereas in-hospital death was recorded in 37 (22%) unvaccinated patients (P = 0.009). Conclusions Significant changes have occurred in the clinical characteristics and outcomes of STEMI patients with COVID-19 infection during the course of the pandemic.
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Affiliation(s)
- Santiago Garcia
- Minneapolis Heart Institute Foundation. Minneapolis, MN; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH
| | - Payam Dehghani
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada
| | | | - Cindy Grines
- Northside Cardiovascular Institute, Atlanta, GA and Society for Cardiovascular Angiography and Interventions (SCAI), Washington, DC
| | | | - Keshav R Nayak
- Department of Cardiology Scripps Mercy Hospital, San Diego, CA
| | - Avneet Singh
- North Shore University Hospital & Long Island Jewish Medical Center (NS/LIJ)
| | | | | | - Nima Ghasemzadeh
- Georgia Heart Institute, Northeast Georgia Medical Center, Gainesville, Georgia
| | - Cristina Sanina
- Montefiore Medical Center and Albert Einstein College of Medicine. New York City, NY
| | | | | | | | - Brynn Okeson
- Minneapolis Heart Institute Foundation. Minneapolis, MN
| | | | - Frederick G Welt
- American College of Cardiology Interventional Cardiology Section Leadership Council, Washington, DC and University of Utah Health Sciences, Salt Lake City, Utah
| | - Laura Davidson
- Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Abdul Moiz Hafiz
- Southern Illinois University School of Medicine. Springfield, IL
| | | | - Jay Stone
- Community Medical Center (RWJ Barnabas Health). Toms River, NJ
| | - Aditya Mehra
- Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ
| | - Shy Amlani
- William Osler Health System- Brampton, Brampton, Ontario, Canada
| | - Ehtisham Mahmud
- University of California, San Diego, Sulpizio Cardiovascular Center, La Jolla CA
| | - Jay Giri
- University of Pennsylvania, Philadelphia, PA
| | - Mehmet Yildiz
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH
| | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH
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10
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Lakhdar S, Buttar C, Guzman Perez L, Nso N, Nassar M, Collura G. ST Elevation Myocardial Infarction in Patients with COVID-19: Case Series. EUROPEAN MEDICAL JOURNAL 2022:38-46. [DOI: 10.33590/emj/21-00264] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2, or COVID-19, has triggered an unprecedented pandemic situation across the globe. Patients with COVID-19 frequently experience a range of clinical complications driven by their health status, comorbidities, and disease responsiveness. Patients with COVID-19 also encounter cardiovascular conditions that potentially increase their risk for mortality. Few clinical studies reveal the development of ST segment elevation myocardial infarction (STEMI) in patients with COVID-19.
New York City, USA, continues to witness and report a high incidence and prevalence of COVID-19 infections. New York City’s healthcare centres and hospitals have treated more than 6,000 cases of COVID-19 pneumonia in their inpatient and intensive care units.
The authors conducted a retrospective study of patients admitted to NYC Health + Hospitals, Queens, New York City, USA, with confirmed COVID-19 reverse transcriptase-PCR test findings between 29th March 2020 and 1st May 2020. The authors used a retrospective case series design to evaluate the association between laboratory-confirmed COVID-19 infection and hospitalisation for acute myocardial infarction. They utilised a series of ECGs to record and analyse STEMI patterns across patients with COVID-19. This study aimed to determine the risk/incidence of STEMI in patients with COVID-19, and its impact on their clinical presentation, angiographic findings, and clinical outcomes. The authors hypothesised STEMI as a significant COVID-19 complication, with the potential to impact the long-term prognostic outcomes of patients with COVID-19.
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Affiliation(s)
- Sofia Lakhdar
- Icahn School of Medicine at Mount Sinai Health System, New York City, USA; NYC Health + Hospitals, Queens, New York City, USA
| | - Chandan Buttar
- Icahn School of Medicine at Mount Sinai Health System, New York City, USA; NYC Health + Hospitals, Queens, New York City, USA
| | - Laura Guzman Perez
- Icahn School of Medicine at Mount Sinai Health System, New York City, USA; NYC Health + Hospitals, Queens, New York City, USA
| | - Nso Nso
- Icahn School of Medicine at Mount Sinai Health System, New York City, USA; NYC Health + Hospitals, Queens, New York City, USA
| | - Mahmoud Nassar
- Icahn School of Medicine at Mount Sinai Health System, New York City, USA; NYC Health + Hospitals, Queens, New York City, USA
| | - Giovina Collura
- Icahn School of Medicine at Mount Sinai Health System, New York City, USA; NYC Health + Hospitals, Queens, New York City, USA
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11
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Alizadehasl A, Eslami S, Vakili K, Habibi Khorasani S, Haghazali M, khalilipur E. A case series of myocardial infarction in SARS-CoV-2-infected patients: Same complication, different outcomes. Clin Case Rep 2022; 10:e05304. [PMID: 35127090 PMCID: PMC8792119 DOI: 10.1002/ccr3.5304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 11/21/2021] [Accepted: 12/22/2021] [Indexed: 01/08/2023] Open
Abstract
Thrombosis is frequently observed in COVID-19, especially in critically ill patients. Management of such life-threatening conditions is of high importance in the context of the current pandemic. Herein, we provide a case series of myocardial infarction in the clinical evolution of COVID-19, emphasizing its importance and implications on the cardiovascular system.
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Affiliation(s)
- Azin Alizadehasl
- CardiologyHead of Cardio‐Oncology Department and Research CenterRajaie Cardiovascular Medical & Research CenterIran University of Medical ScienceTehranIran
| | - Samira Eslami
- EchocardiologistDepartment of Adult EchocardiographyRajaie Cardiovascular Medical and Research CenterTehranIran
- Present address:
Shahid Rajaei Cardiovascular TrainingResearch and Treatment CenterSt. TehranIran
| | - Kimia Vakili
- Student Research CommitteeFaculty of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Shirin Habibi Khorasani
- EchocardiologistDepartment of Adult EchocardiographyRajaie Cardiovascular Medical and Research CenterTehranIran
| | - Mehrdad Haghazali
- GastroenterologistRajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Ehsan khalilipur
- Interventional CardiologistCardiovascular Intervention Research CenterRajaie Cardiovascular Medical and Research CenterTehranIran
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12
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Abate SM, Mantefardo B, Nega S, Chekole YA, Basu B, Ali SA, Taddesse M. Global burden of acute myocardial injury associated with COVID-19: A systematic review, meta-analysis, and meta-regression. Ann Med Surg (Lond) 2021; 68:102594. [PMID: 34336202 PMCID: PMC8316689 DOI: 10.1016/j.amsu.2021.102594] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/16/2021] [Accepted: 07/25/2021] [Indexed: 12/12/2022] Open
Abstract
Background The body of evidence showed that there is a strong correlation between acute myocardial Injury and COVID-19 infection. However, the link between acute myocardial infection and COVID-19, the prevalence, reliability of diagnostic modalities, independent predictors, and clinical outcomes are still uncertain and a topic of debate. The current study was designed to determine the prevalence, determinants, and outcomes of acute myocardial injury based on a systematic review and meta-analysis the global published peer-reviewed works of literature. Methods A comprehensive search was conducted in PubMed/Medline; Science direct, CINHAL, and LILACS from December 2019 to May 2021. All observational studies reporting the prevalence of AMI were included while case reports and reviews were excluded. The data were extracted with two independent authors in a customized format. The methodological quality of included studies was evaluated using the Newcastle-Ottawa appraisal tool. Results A total of 397 articles were identified from different databases. Thirty-seven Articles with 21, 204 participants were included while seven studies were excluded. The meta-analysis revealed that the pooled prevalence of myocardial injury during the COVID-19 pandemic was 22.33 % (95 % CI: 17.86 to 26.81, 37). Conclusion Our meta-analysis showed that mortality among patients with an acute myocardial injury during COVID-19 was more than four times more likely as compared to those without AMI. This necessitates a mitigating strategy to prevent and manage before its clinical outcomes getting worse. The meta-analysis revealed that more than one-fifth of patients with COVID-19 sustained AMI ∙The incidence of mortality among patients with AMI during COVID-19 pandemic was four times more likely as compared those without AMI ∙Prevalence of AMI was three times more likely in patients with history of Coronary artery disease ∙Smoking and hypertension were the independent predictors of acute myocardial Injury
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Affiliation(s)
- Semagn Mekonnen Abate
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Bahiru Mantefardo
- Departemnt of Internal Medicine, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Solomon Nega
- Departemnt of Internal Medicine, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Yigrem Ali Chekole
- Departemnt of Psychiatry, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Bivash Basu
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Siraj Ahmed Ali
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Moges Taddesse
- Public Health, College of Health Sciences and Medicine, Dilla University, Ethiopia
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13
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Sturm RC, Jones TL, Youngquist ST, Shah RU. Regional Systems of Care in ST Elevation Myocardial Infarction. Interv Cardiol Clin 2021; 10:281-291. [PMID: 34053615 DOI: 10.1016/j.iccl.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
ST-segment elevation myocardial infarction is a medical emergency with significant health care delivery challenges to ensure rapid triage and treatment. Several developments over the past decades have led to improved care delivery, decreased time to reperfusion, and decreased mortality. Still, significant challenges remain to further optimize the delivery of care for this patient population.
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Affiliation(s)
- Robert C Sturm
- Division of Cardiovascular Medicine, University of Utah, 30 N. 1900 E, Room 4A100, Salt Lake City, UT, 84132, USA.
| | - Tara L Jones
- Division of Cardiovascular Medicine, University of Utah, 30 N. 1900 E, Room 4A100, Salt Lake City, UT, 84132, USA
| | - Scott T Youngquist
- Division of Emergency Medicine, University of Utah, 30 N 1900 E 1C026, Salt Lake City, UT 84132, USA
| | - Rashmee U Shah
- Division of Cardiovascular Medicine, University of Utah, 30 N. 1900 E, Room 4A100, Salt Lake City, UT, 84132, USA
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14
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Siscel J, Short M, Flynn B. Understanding ST-Elevation Myocardial Infarction in COVID-19: The Marriage of Bench Work and Big Data. J Cardiothorac Vasc Anesth 2021; 35:3164-3166. [PMID: 34218995 PMCID: PMC8180361 DOI: 10.1053/j.jvca.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Jordan Siscel
- Department of Anesthesiology, The University of Kansas Health System, Kansas City, KS
| | - Margo Short
- Department of Anesthesiology, The University of Kansas Health System, Kansas City, KS
| | - Brigid Flynn
- Department of Anesthesiology, The University of Kansas Health System, Kansas City, KS.
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15
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Abstract
Purpose of review The emergence of severe acute respiratory syndrome coronavirus 2 virus, which causes coronavirus disease 2019 (COVID-19), led to the declaration of a global pandemic by the World Health Organization on March 11, 2020. As of February 6, 2021, over 105 million persons have been infected in 223 countries and there have been 2,290,488 deaths. As a result, emergency medical services and hospital systems have undergone unprecedented healthcare delivery reconfigurations. Here, we review the effects of the COVID-19 pandemic on out-of-hospital cardiac arrest (OHCA) epidemiology and systems of care. Recent findings Areas severely affected by the pandemic have reported increased incidence of OHCA, lower rates of successful resuscitation, and increased mortality. COVID-19 has significantly impacted patient outcomes through increased disease severity, decreased access to care, and the reshaping of emergency medical response and hospital-based healthcare systems and policies. The pandemic has negatively influenced attitudes toward resuscitation and challenged providers with novel ethical dilemmas provoked by the scarcity of healthcare resources. Summary The COVID-19 pandemic has had direct, indirect, psychosocial, and ethical impacts on the cardiac arrest chain of survival.
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16
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Garcia S, Dehghani P, Grines C, Davidson L, Nayak KR, Saw J, Waksman R, Blair J, Akshay B, Garberich R, Schmidt C, Ly HQ, Sharkey S, Mercado N, Alfonso CE, Misumida N, Acharya D, Madan M, Hafiz AM, Javed N, Shavadia J, Stone J, Alraies MC, Htun W, Downey W, Bergmark BA, Ebinger J, Alyousef T, Khalili H, Hwang CW, Purow J, Llanos A, McGrath B, Tannenbaum M, Resar J, Bagur R, Cox-Alomar P, Stefanescu Schmidt AC, Cilia LA, Jaffer FA, Gharacholou M, Salinger M, Case B, Kabour A, Dai X, Elkhateeb O, Kobayashi T, Kim HH, Roumia M, Aguirre FV, Rade J, Chong AY, Hall HM, Amlani S, Bagherli A, Patel RAG, Wood DA, Welt FG, Giri J, Mahmud E, Henry TD. Initial Findings From the North American COVID-19 Myocardial Infarction Registry. J Am Coll Cardiol 2021; 77:1994-2003. [PMID: 33888249 PMCID: PMC8054772 DOI: 10.1016/j.jacc.2021.02.055] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 12/18/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has impacted many aspects of ST-segment elevation myocardial infarction (STEMI) care, including timely access to primary percutaneous coronary intervention (PPCI). Objectives The goal of the NACMI (North American COVID-19 and STEMI) registry is to describe demographic characteristics, management strategies, and outcomes of COVID-19 patients with STEMI. Methods A prospective, ongoing observational registry was created under the guidance of 3 cardiology societies. STEMI patients with confirmed COVID+ (group 1) or suspected (person under investigation [PUI]) (group 2) COVID-19 infection were included. A group of age- and sex-matched STEMI patients (matched to COVID+ patients in a 2:1 ratio) treated in the pre-COVID era (2015 to 2019) serves as the control group for comparison of treatment strategies and outcomes (group 3). The primary outcome was a composite of in-hospital death, stroke, recurrent myocardial infarction, or repeat unplanned revascularization. Results As of December 6, 2020, 1,185 patients were included in the NACMI registry (230 COVID+ patients, 495 PUIs, and 460 control patients). COVID+ patients were more likely to have minority ethnicity (Hispanic 23%, Black 24%) and had a higher prevalence of diabetes mellitus (46%) (all p < 0.001 relative to PUIs). COVID+ patients were more likely to present with cardiogenic shock (18%) but were less likely to receive invasive angiography (78%) (all p < 0.001 relative to control patients). Among COVID+ patients who received angiography, 71% received PPCI and 20% received medical therapy (both p < 0.001 relative to control patients). The primary outcome occurred in 36% of COVID+ patients, 13% of PUIs, and 5% of control patients (p < 0.001 relative to control patients). Conclusions COVID+ patients with STEMI represent a high-risk group of patients with unique demographic and clinical characteristics. PPCI is feasible and remains the predominant reperfusion strategy, supporting current recommendations.
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Affiliation(s)
- Santiago Garcia
- Minneapolis Heart Institute Foundation. Minneapolis, Minnesota, USA.
| | | | - Cindy Grines
- Northside Cardiovascular Institute, Atlanta, Georgia, USA; Society for Cardiovascular Angiography and Interventions, Washington, DC, USA
| | - Laura Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Keshav R Nayak
- Department of Cardiology, Scripps Mercy Hospital, San Diego, California, USA
| | - Jacqueline Saw
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Ron Waksman
- MedStar Washington Hospital Center, Washington, DC, USA
| | - John Blair
- University of Chicago, Chicago, Illinois, USA
| | - Bagai Akshay
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ross Garberich
- Minneapolis Heart Institute Foundation. Minneapolis, Minnesota, USA
| | | | - Hung Q Ly
- University of Montreal, Montreal, Quebec, Canada
| | - Scott Sharkey
- Minneapolis Heart Institute Foundation. Minneapolis, Minnesota, USA
| | | | | | | | - Deepak Acharya
- University of Arizona Sarver Heart Center, Tucson, Arizona, USA
| | - Mina Madan
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Abdul Moiz Hafiz
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Nosheen Javed
- Southcoast Health System, New Bedford, Massachusetts, USA
| | - Jay Shavadia
- Royal University Hospital, Saskatchewan Health, Saskatoon, Saskatchewan, Canada
| | - Jay Stone
- Community Medical Center, RWJ Barnabas Health, Toms River, New Jersey, USA
| | | | - Wah Htun
- Gundersen Health System, La Crosse, Wisconsin, USA
| | - William Downey
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Brian A Bergmark
- TIMI Study Group, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jospeh Ebinger
- Cedars Sinai Heart Institute, Los Angeles, California, USA
| | - Tareq Alyousef
- Cook County Health and Hospitals System, Chicago, Illinois, USA
| | - Houman Khalili
- Delray Medical Center, Tenet Healthcare, Delray Beach, Florida, USA
| | - Chao-Wei Hwang
- Frederick Health Hospital, Frederick, Maryland, USA; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joshua Purow
- Holy Cross Hospital, Fort Lauderdale, Florida, USA
| | | | - Brent McGrath
- Horizon Health Network, Saint John, New Brunswick, Canada
| | | | - Jon Resar
- Frederick Health Hospital, Frederick, Maryland, USA, and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rodrigo Bagur
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | | | | | | | | | | | | | - Brian Case
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Ameer Kabour
- Mercy St. Vincent's Medical Center, Toledo, Ohio, USA
| | - Xuming Dai
- NewYork-Presbyterian Queens, Flushing, New York, USA
| | | | | | - Hahn-Ho Kim
- St. Mary's General Hospital, Kitchener, Ontario, Canada
| | - Mazen Roumia
- St. Vincent Hospital, Worcester, Massachusetts, USA
| | - Frank V Aguirre
- Prairie Heart Institute at HSHS St. John's Hospital, Springfield, Illinois, USA
| | - Jeffrey Rade
- UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Aun-Yeong Chong
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Hurst M Hall
- UT Southwestern Medical Center, Dallas, Texas, USA
| | - Shy Amlani
- William Osler Health System, Brampton, Ontario, Canada
| | | | | | - David A Wood
- Canadian Association of Interventional Cardiology, Ottawa, Ontario, Canada
| | - Frederick G Welt
- American College of Cardiology Interventional Cardiology Section Leadership Council, Washington, DC, USA; University of Utah Health Sciences, Salt Lake City, Utah, USA
| | - Jay Giri
- University of Pennsylvania, Philadelphia, Pennsylvania, USA. https://twitter.com/jaygirimd
| | - Ehtisham Mahmud
- Sulpizio Cardiovascular Center, University of California San Diego, La Jolla, California, USA
| | - Timothy D Henry
- Carl and Edyth Lindner Center for Research and Education, the Christ Hospital, Cincinnati, Ohio, USA. https://twitter.com/HenrytTimothy
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17
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Zhou S, Dong X, Liu F, Zhang Y, Yue D, Zhou Q, Jin Y, Zheng ZJ. A stepped wedge cluster randomized control trial to evaluate the implementation and effectiveness of optimized initiatives in improving quality of care for ST segment elevation myocardial infarction in response to the COVID-19 outbreak. Implement Sci 2021; 16:38. [PMID: 33845863 PMCID: PMC8040354 DOI: 10.1186/s13012-021-01107-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/29/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The National Chest Pain Center Accreditation Program (CHANGE) is the first hospital-based, multifaceted, nationwide quality improvement (QI) initiative, to monitor and improve the quality of the ST segment elevation myocardial infarction (STEMI) care in China. The QI initiatives, as implementation strategies, include a bundle of evidence-based interventions adapted for implementation in China. During the pandemic of coronavirus disease 2019 (COVID-19), fear of infection with severe acute respiratory syndrome coronavirus 2, national lockdowns, and altered health care priorities have highlighted the program's importance in improving STEMI care quality. This study aims to minimize the adverse impact of the COVID-19 pandemic on the quality of STEMI care, by developing interventions that optimize the QI initiatives, implementing and evaluating the optimized QI initiatives, and developing scale-up activities of the optimized QI initiatives in response to COVID-19 and other public health emergencies. METHODS A stepped wedge cluster randomized control trial will be conducted in three selected cities of China: Wuhan, Suzhou, and Shenzhen. Two districts have been randomly selected in each city, yielding a total of 24 registered hospitals. This study will conduct a rollout in these hospitals every 3 months. The 24 hospitals will be randomly assigned to four clusters, and each cluster will commence the intervention (optimized QI initiatives) at one of the four steps. We will conduct hospital-based assessments, questionnaire surveys among health care providers, community-based household surveys, and key informant interviews during the trial. All outcome measures will be organized using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, including implementation outcomes, service outcomes (e.g., treatment time), and patient outcomes (e.g., in-hospital mortality and 1-year complication). The Consolidated Framework for Implementation Research framework will be used to identify factors that influence implementation of the optimized QI interventions. DISCUSSION The study findings could be translated into a systematic solution to implementing QI initiatives in response to COVID-19 and future potential major public health emergencies. Such actionable knowledge is critical for implementors of scale-up activities in low- and middle-income settings. TRIAL REGISTRATION ChiCTR 2100043319 . Registered on 10 February 2021.
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Affiliation(s)
- Shuduo Zhou
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health, Peking University, Beijing, China
| | - Xuejie Dong
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health, Peking University, Beijing, China
| | - Fangjing Liu
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health, Peking University, Beijing, China
| | - Yan Zhang
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Dahai Yue
- University of Maryland, College Park, USA
| | - Qiang Zhou
- Shenzhen Center for Prehospital Care, Shenzhen, China
| | - Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
- Institute for Global Health, Peking University, Beijing, China.
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
- Institute for Global Health, Peking University, Beijing, China
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18
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Ji N, Xiang T, Bonato P, Lovell NH, Ooi SY, Clifton DA, Akay M, Ding XR, Yan BP, Mok V, Fotiadis DI, Zhang YT. Recommendation to Use Wearable-Based mHealth in Closed-Loop Management of Acute Cardiovascular Disease Patients During the COVID-19 Pandemic. IEEE J Biomed Health Inform 2021; 25:903-908. [PMID: 33596179 PMCID: PMC8545171 DOI: 10.1109/jbhi.2021.3059883] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/10/2021] [Accepted: 02/13/2021] [Indexed: 11/08/2022]
Abstract
Because of the rapid and serious nature of acute cardiovascular disease (CVD) especially ST segment elevation myocardial infarction (STEMI), a leading cause of death worldwide, prompt diagnosis and treatment is of crucial importance to reduce both mortality and morbidity. During a pandemic such as coronavirus disease-2019 (COVID-19), it is critical to balance cardiovascular emergencies with infectious risk. In this work, we recommend using wearable device based mobile health (mHealth) as an early screening and real-time monitoring tool to address this balance and facilitate remote monitoring to tackle this unprecedented challenge. This recommendation may help to improve the efficiency and effectiveness of acute CVD patient management while reducing infection risk.
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Affiliation(s)
- Nan Ji
- Department of Biomedical EngineeringCity University of Hong KongHong Kong999077China
| | - Ting Xiang
- Department of Biomedical EngineeringCity University of Hong KongHong Kong999077China
| | - Paolo Bonato
- Department of Physical Medicine and RehabilitationHarvard Medical SchoolBostonMA02115USA
| | - Nigel H. Lovell
- Graduate School of Biomedical EngineeringUniversity of New South WalesSydneyNSW2052Australia
| | - Sze-Yuan Ooi
- Department of Cardiology, Prince of Wales Clinical School, School of MedicineUniversity of New South WalesSydneyNSW2052Australia
| | - David A. Clifton
- Department of Engineering ScienceUniversity of OxfordOxfordOX1 2JDU.K.
| | - Metin Akay
- Department of Biomedical EngineeringUniversity of HoustonHoustonTX77204USA
| | - Xiao-Rong Ding
- School of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengdu611731China
| | - Bryan P. Yan
- Heart & Vascular InstituteDivision of Cardiology, Department of Medicine and Therapeutics, Faculty of Medicine Chinese University of Hong KongHong Kong999077China
| | - Vincent Mok
- Lui Che Woo Institute of Innovative Medicine, Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of MedicineThe Chinese University of Hong KongHong Kong999077China
| | - Dimitrios I. Fotiadis
- Department of Biomedical ResearchInstitute of Molecular Biology and Biotechnology FORTHIoanninaGreece
- Department of Materials Science and Engineering, Unit of Medical Technology and Intelligent Information SystemsUniversity of Ioannina45110IoanninaGreece
| | - Yuan-Ting Zhang
- Hong Kong Center for Cerebro-cardiovascular Health Engineering (COCHE) at Hong Kong Science and Technology ParkDepartment of Biomedical Engineering at City University of Hong KongHong Kong999077China
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19
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Case Selection During the COVID-19 Pandemic: Who Should Go to the Cardiac Catheterization Laboratory? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021; 23:27. [PMID: 33758493 PMCID: PMC7972331 DOI: 10.1007/s11936-020-00892-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 12/14/2022]
Abstract
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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Alonderytė A, Navickas G, Samalavičius RS, Šerpytis P. Review of New Clinical Aspects of Cardiac Pathology in Patients with COVID-19 Infection. Acta Med Litu 2021; 28:31-35. [PMID: 34393626 PMCID: PMC8311833 DOI: 10.15388/amed.2021.28.1.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/17/2021] [Indexed: 11/27/2022] Open
Abstract
Summary. Background: COVID-19 disease is a huge burden for society and healthcare specialists. As more information is gathered about this new disease, it becomes clear that it affects not only respiratory, but also cardiovascular system. Materials and Methods: The aim of this review is to analyse the information about myocardial injury caused by COVID-19 and overview treatment options for these patients in publications which were published in the last 5 years. The data for this overview were collected in the PubMed database. Full-text articles were used for analysis when their title, summary, or keywords matched the purpose of the review. Only publications published in English that appeared in the last 5 years were analysed. For the analysis 14 publications were selected and analysed. Conclusion: COVID-19 infection could mimic ST-elevation myocardial infarction and it is crucial to differentiate the main cause and choose the appropriate treatment. Cardiovascular complications are related with poorer prognosis and higher mortality. This should be thoroughly considered by the healthcare specialists in order to choose appropriate treatment strategy. Patients with acute coronary syndrome (ACS) due to plaque rupture should receive dual antiplatelet therapy and full-dose anticoagulation if it is not contraindicated. Therefore, priority should be given to the acute coronary syndrome given the low evidence of new antiviral treatment effectiveness. Number of agents which are under investigation for COVID-19 may have interactions with oral antiplatelet drugs. Selected patients could receive immunosuppressive treatment as well as extracorporeal membrane oxygenation as a bridge to recovery.
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Affiliation(s)
| | - Giedrius Navickas
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Robertas Stasys Samalavičius
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, LithuaniaEmergency Medicine Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Pranas Šerpytis
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, LithuaniaInstitute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, LithuaniaEmergency Medicine Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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21
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Verhoef PA, Kannan S, Sturgill JL, Tucker EW, Morris PE, Miller AC, Sexton TR, Koyner JL, Hejal R, Brakenridge SC, Moldawer LL, Hotchkiss RS, Blood TM, Mazer MB, Bolesta S, Alexander SA, Armaignac DL, Shein SL, Jones C, Hoemann CD, Doctor A, Friess SH, Parker RI, Rotta AT, Remy KE. Severe Acute Respiratory Syndrome-Associated Coronavirus 2 Infection and Organ Dysfunction in the ICU: Opportunities for Translational Research. Crit Care Explor 2021; 3:e0374. [PMID: 33786450 PMCID: PMC7994036 DOI: 10.1097/cce.0000000000000374] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Since the beginning of the coronavirus disease 2019 pandemic, hundreds of thousands of patients have been treated in ICUs across the globe. The severe acute respiratory syndrome-associated coronavirus 2 virus enters cells via the angiotensin-converting enzyme 2 receptor and activates several distinct inflammatory pathways, resulting in hematologic abnormalities and dysfunction in respiratory, cardiac, gastrointestinal renal, endocrine, dermatologic, and neurologic systems. This review summarizes the current state of research in coronavirus disease 2019 pathophysiology within the context of potential organ-based disease mechanisms and opportunities for translational research. DATA SOURCES Investigators from the Research Section of the Society of Critical Care Medicine were selected based on expertise in specific organ systems and research focus. Data were obtained from searches conducted in Medline via the PubMed portal, Directory of Open Access Journals, Excerpta Medica database, Latin American and Caribbean Health Sciences Literature, and Web of Science from an initial search from December 2019 to October 15, 2020, with a revised search to February 3, 2021. The medRxiv, Research Square, and clinical trial registries preprint servers also were searched to limit publication bias. STUDY SELECTION Content experts selected studies that included mechanism-based relevance to the severe acute respiratory syndrome-associated coronavirus 2 virus or coronavirus disease 2019 disease. DATA EXTRACTION Not applicable. DATA SYNTHESIS Not applicable. CONCLUSIONS Efforts to improve the care of critically ill coronavirus disease 2019 patients should be centered on understanding how severe acute respiratory syndrome-associated coronavirus 2 infection affects organ function. This review articulates specific targets for further research.
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Affiliation(s)
- Philip A Verhoef
- Department of Medicine, University of Hawaii-Manoa, Honolulu, HI
- Kaiser Permanente Hawaii, Honolulu, HI
| | - Sujatha Kannan
- Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jamie L Sturgill
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, KY
| | - Elizabeth W Tucker
- Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Peter E Morris
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, KY
| | - Andrew C Miller
- Department of Emergency Medicine, Nazareth Hospital, Philadelphia, PA
| | - Travis R Sexton
- Department of Internal Medicine, The University of Kentucky-Lexington School of Medicine, The Gill Heart and Vascular Institute, Lexington, KY
| | - Jay L Koyner
- Section of Nephrology, University of Chicago, Chicago, IL
| | - Rana Hejal
- Department of Internal Medicine, Division of Pulmonary Critical Care, Case Western School of Medicine, Cleveland, OH
| | - Scott C Brakenridge
- Department of Surgery, Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL
| | - Lyle L Moldawer
- Department of Surgery, Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, FL
| | - Richard S Hotchkiss
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO
- Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine, St. Louis, MO
- Department of Surgery, St. Louis, Washington University School of Medicine, MO
| | - Teresa M Blood
- Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine, St. Louis, MO
| | - Monty B Mazer
- Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine, St. Louis, MO
| | - Scott Bolesta
- Department of Pharmacy Practice, Nesbitt School of Pharmacy, Wilkes University, Wilkes-Barre, PA
| | | | | | - Steven L Shein
- Department of Pediatrics, Division of Critical Care, Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Christopher Jones
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO
| | | | - Allan Doctor
- Department of Pediatrics, Division of Critical Care Medicine, The University of Maryland School of Medicine, Baltimore, MD
| | - Stuart H Friess
- Department of Pediatrics, Division of Critical Care Medicine, Washington University School of Medicine, St. Louis, MO
| | - Robert I Parker
- Department of Pediatrics, Hematology Hematology/Oncology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY
| | - Alexandre T Rotta
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, NC
| | - Kenneth E Remy
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO
- Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine, St. Louis, MO
- Department of Pediatrics, Division of Critical Care Medicine, Washington University School of Medicine, St. Louis, MO
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22
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Young MN, Iribarne A, Malenka D. COVID-19 and Cardiovascular Health: This Is a Public Service Announcement. J Am Coll Cardiol 2021; 77:170-172. [PMID: 33446310 PMCID: PMC7833848 DOI: 10.1016/j.jacc.2020.11.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 12/05/2022]
Affiliation(s)
- Michael N Young
- Division of Cardiology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.
| | - Alexander Iribarne
- Division of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - David Malenka
- Division of Cardiology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
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23
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Brindis RG, Bates ER, Henry TD. Value of Registries in ST-Segment-Elevation Myocardial Infarction Care in Both the Pre-Coronavirus Disease 2019 and the Coronavirus Disease 2019 Eras. J Am Heart Assoc 2020; 10:e019958. [PMID: 33345555 PMCID: PMC7955494 DOI: 10.1161/jaha.120.019958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Ralph G Brindis
- Department of Medicine and the Philip R. Lee Institute for Health Policy Studies University of California, San Francisco CA
| | - Eric R Bates
- Division of Cardiovascular Medicine Department of Internal Medicine University of Michigan Ann Arbor MI
| | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education The Christ Hospital Cincinnati OH
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24
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Pelle MC, Tassone B, Ricchio M, Mazzitelli M, Davoli C, Procopio G, Cancelliere A, La Gamba V, Lio E, Matera G, Quirino A, Barreca GS, Trecarichi EM, Torti C. Late-onset myocardial infarction and autoimmune haemolytic anaemia in a COVID-19 patient without respiratory symptoms, concomitant with a paradoxical increase in inflammatory markers: a case report. J Med Case Rep 2020; 14:246. [PMID: 33339534 PMCID: PMC7746982 DOI: 10.1186/s13256-020-02595-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/19/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND In December 2019, a new coronavirus (named severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) spread from China, causing a pandemic in a very short time. The main clinical presentation of SARS-CoV-2 infection (COVID-19, coronavirus disease-2019) is pneumonia, but several cardiovascular complications may also occur (e.g., acute coronary syndromes, pulmonary embolism, stroke, arrhythmias, heart failure and cardiogenic shock). Direct or indirect mechanisms induced by SARS-CoV-2 could be implicated in the pathogenesis of these events. CASE PRESENTATION We report herein the third case of COVID-19 autoimmune haemolytic anaemia (AIHA) reported so far, which occurredwithout any other possible explanations in a Caucasian patient. The patient also suffered from ST-elevation myocardial injury. CONCLUSIONS Both complications occurred quite late after COVID-19 diagnosis and were probably precipitated by systemic inflammation, as indicated by a significant delayed increase in inflammatory markers, including interleukin-6 (IL-6).
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Affiliation(s)
- Maria Chiara Pelle
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy.
| | - Bruno Tassone
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Marco Ricchio
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Maria Mazzitelli
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Chiara Davoli
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Giada Procopio
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Anna Cancelliere
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Valentina La Gamba
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Elena Lio
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Giovanni Matera
- Department of Health Sciences, Unit of Clinical Microbiology, University "Magna Graecia", Catanzaro, Italy
| | - Angela Quirino
- Department of Health Sciences, Unit of Clinical Microbiology, University "Magna Graecia", Catanzaro, Italy
| | | | - Enrico Maria Trecarichi
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Carlo Torti
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
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25
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Li Y, Liu T, Tse G, Wu M, Jiang J, Liu M, Tao L. Electrocardiograhic characteristics in patients with coronavirus infection: A single-center observational study. Ann Noninvasive Electrocardiol 2020; 25:e12805. [PMID: 32951285 PMCID: PMC7536937 DOI: 10.1111/anec.12805] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 08/26/2020] [Accepted: 08/31/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND A global outbreak of coronavirus disease (COVID-19), caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), has emerged since December 2019, in Wuhan, China. However, electrocardiograhic (ECG) manifestations of patients with COVID-19 have not been fully described. We aim to investigate ECG characteristics in COVID-19 patients and risk factors of intensive care unit (ICU) admission. METHODS This retrospective observational study included the patients with COVID-19 at the Wuhan Asia General hospital between February 10, and 26, 2020. Demographic, clinical, and ECG characteristics were collected, and comparisons were made between the ICU and non-ICU admission groups. Logistic regression was used to identify risk factors of ICU admission. RESULTS Among 135 included patients (median age: 64 years [interquartile range: 48-72]), ST-T abnormalities (40%) were the most common ECG feature, followed by arrhythmias (38%). Cardiovascular disease (CVD) was presented in 48% of the patients. Six (4.4%) died during hospitalization, and 23 (17.0%) were admitted to the ICU. Compared with non-ICU group, the ICU group showed higher heart rate (p = .019) and P-wave duration (p = .039) and was more frequently associated with CVD (p < .001), ST-T abnormalities (p = .007), arrhythmias (p = .003), QTc interval prolongation (p = .003), and pathological Q waves (p < .001). Twenty-seven patients were re-examined ECG during admission, and 17 of them presented new findings compared with their initial ECG presentations. ST-T abnormalities (p = .040) and history of CVD (p = .0047) were associated with increased risk of ICU hospitalization. CONCLUSIONS COVID-19 is frequently related to cardiovascular manifestations including ECG abnormalities and cardiovascular comorbidities. ST-T abnormalities and CVD at admission were associated with increased odds of ICU admission.
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Affiliation(s)
- Yi Li
- Department of Cardiothoracic SurgeryWuhan Asia Heart Hospital Affiliated to Wuhan University of Science and TechnologyHubeiChina
| | - Tong Liu
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular DiseaseDepartment of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Gary Tse
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular DiseaseDepartment of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Mingxiang Wu
- Departments of Intensive Care UnitWuhan Asia General HospitalHubeiChina
| | - Jingjing Jiang
- Departments of Heart CenterWuhan Asia General HospitalHubeiChina
| | - Ming Liu
- Department of Cardiac FunctionWuhan Asia Heart Hospital Affiliated to Wuhan University of Science and TechnologyHubeiChina
| | - Liang Tao
- Department of Cardiothoracic SurgeryWuhan Asia Heart Hospital Affiliated to Wuhan University of Science and TechnologyHubeiChina
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26
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Yildiz M, Sharkey S, Aguirre FV, Tannenbaum M, Garberich R, Smith TD, Shivapour D, Schmidt CW, Pacheco-Coronado R, Rohm HS, Chambers J, Coulson T, Garcia S, Henry TD. The Midwest ST-Elevation Myocardial Infarction Consortium: Design and Rationale. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 23:86-90. [PMID: 32883587 PMCID: PMC7425714 DOI: 10.1016/j.carrev.2020.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Over the past 20 years, the development of regional ST-elevation myocardial infarction (STEMI) care systems has led to remarkable progress in achieving timely coronary reperfusion with attendant improvement in clinical outcomes, including survival. Despite this progress, contemporary STEMI care does not consistently meet the national guideline-recommended goals, which offers an opportunity for further improvement in STEMI outcomes. The lack of single, comprehensive, national STEMI registry complicates our ability to improve STEMI outcomes in particular for high-risk STEMI subsets such as cardiac arrest (CA) and/or cardiogenic shock (CS). OBJECTIVES To address this need, the Midwest STEMI Consortium (MSC) was created as a collaboration of 4 large, regional STEMI care systems to provide a comprehensive, multicenter, and prospective STEMI registry without any exclusionary criteria. METHODS The MSC is a collaboration of 4 large, regional STEMI care systems: Iowa Heart Center in Des Moines, IA; Minneapolis Heart Institute Foundation in Minneapolis, MN; Prairie Heart Institute in Springfield, IL; and The Christ Hospital in Cincinnati, OH. Each has similar standardized STEMI protocol and together include 6 percutaneous coronary intervention (PCI)-capable hospitals and over 100 non-PCI-capable hospitals. Each center had a prospective database that was transferred to a data coordinating center to create the multicenter database. The comprehensive database includes traditional risk factors, cardiovascular history, medications, time to treatment data, detailed angiographic characteristics, and short- and long-term clinical outcomes up to 5-year for myocardial infarction, stroke, and cardiovascular and all-cause mortality. Ten-year mortality rates were assessed by using national death index. RESULTS Currently, the comprehensive database (03/2003-01/2020) includes 14,911 consecutive STEMI patients with mean age of 62.3 ± 13.6 years, female gender (29%), and left anterior descending artery as the culprit vessel (34%). High risk features included: Age >75 years (19%), left ventricular ejection fraction <35% (15%), CA (10%), and CS (8%). CONCLUSION This collaboration of 4 large, regional STEMI care systems with broad entry criteria including high-risk STEMI subsets such as CA and/or CS provides a unique platform to conduct clinical research studies to optimize STEMI care.
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Affiliation(s)
- Mehmet Yildiz
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH, United States of America
| | - Scott Sharkey
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, United States of America
| | - Frank V Aguirre
- Prairie Heart Institute at St John's Hospital, Springfield, IL, United States of America
| | | | - Ross Garberich
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, United States of America
| | - Timothy D Smith
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH, United States of America
| | | | - Christian W Schmidt
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, United States of America
| | | | - Heather S Rohm
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH, United States of America
| | - Jenny Chambers
- Prairie Heart Institute at St John's Hospital, Springfield, IL, United States of America
| | - Teresa Coulson
- Iowa Heart Center, Des Moines, IA, United States of America
| | - Santiago Garcia
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, United States of America
| | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH, United States of America.
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27
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Nogueira PJ, de Araújo Nobre M, Costa A, Ribeiro RM, Furtado C, Bacelar Nicolau L, Camarinha C, Luís M, Abrantes R, Vaz Carneiro A. The Role of Health Preconditions on COVID-19 Deaths in Portugal: Evidence from Surveillance Data of the First 20293 Infection Cases. J Clin Med 2020; 9:E2368. [PMID: 32722159 PMCID: PMC7464004 DOI: 10.3390/jcm9082368] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/08/2020] [Accepted: 07/18/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND It is essential to study the effect of potential co-factors on the risk of death in patients infected by COVID-19. The identification of risk factors is important to allow more efficient public health and health services strategic interventions with a significant impact on deaths by COVID-19. This study aimed to identify factors associated with COVID-19 deaths in Portugal. METHODS A national dataset with the first 20,293 patients infected with COVID-19 between 1 January and 21 April 2020 was analyzed. The primary outcome measure was mortality by COVID-19, measured (registered and confirmed) by Medical Doctors serving as health delegates on the daily death registry. A logistic regression model using a generalized linear model was used for estimating Odds Ratio (OR) with 95% confidence intervals (95% CI) for each potential risk indicator. RESULTS A total of 502 infected patients died of COVID-19. The risk factors for increased odds of death by COVID-19 were: sex (male: OR = 1.47, ref = female), age ((56-60) years, OR = 6.01; (61-65) years, OR = 10.5; (66-70) years, OR = 20.4; (71-75) years, OR = 34; (76-80) years, OR = 50.9; (81-85) years, OR = 70.7; (86-90) years, OR = 83.2; (91-95) years, OR = 91.8; (96-104) years, OR = 140.2, ref = (0-55)), Cardiac disease (OR = 2.86), Kidney disorder (OR = 2.95), and Neuromuscular disorder (OR = 1.58), while condition (None (absence of precondition); OR = 0.49) was associated with a reduced chance of dying after adjusting for other variables of interest. CONCLUSIONS Besides age and sex, preconditions justify the risk difference in mortality by COVID-19.
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Affiliation(s)
- Paulo Jorge Nogueira
- IMPSP—Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; (C.F.); (L.B.N.); (A.V.C.)
- Laboratório de Biomatemática, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal;
- ISBE—Instituto de Saúde Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- ISAMB—Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal;
| | - Miguel de Araújo Nobre
- Clínica Universitária de Estomatologia, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal;
- UEPID—Unidade de Epidemiologia, Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; (C.C.); (M.L.); (R.A.)
| | - Andreia Costa
- ISAMB—Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal;
- ESEL—Escola Superior de Enfermagem de Lisboa, Polo Calouste Gulbenkian Avenida Prof Egas Moniz, 1600-190 Lisboa, Portugal
- CRC-W—Católica Research Centre for Psychological, Family and Social Wellbeing, Universidade Católica Portuguesa, Palma de Cima, 1649-023 Lisboa, Portugal
| | - Ruy M. Ribeiro
- Laboratório de Biomatemática, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal;
- ISAMB—Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal;
| | - Cristina Furtado
- IMPSP—Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; (C.F.); (L.B.N.); (A.V.C.)
- UEPID—Unidade de Epidemiologia, Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; (C.C.); (M.L.); (R.A.)
- National Institute of Health Dr. Ricardo Jorge, Av. Padre Cruz, 1600-560 Lisboa, Portugal
| | - Leonor Bacelar Nicolau
- IMPSP—Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; (C.F.); (L.B.N.); (A.V.C.)
- ISAMB—Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal;
| | - Catarina Camarinha
- UEPID—Unidade de Epidemiologia, Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; (C.C.); (M.L.); (R.A.)
| | - Márcia Luís
- UEPID—Unidade de Epidemiologia, Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; (C.C.); (M.L.); (R.A.)
| | - Ricardo Abrantes
- UEPID—Unidade de Epidemiologia, Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; (C.C.); (M.L.); (R.A.)
| | - António Vaz Carneiro
- IMPSP—Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; (C.F.); (L.B.N.); (A.V.C.)
- ISBE—Instituto de Saúde Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Cochrane Portugal, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
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28
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Natarajan MK, Wijeysundera HC, Oakes G, Cantor WJ, Miner SES, Welsford M, Cheskes S, Le May MR, Jeffrey J, Ko DT. Early Observations During the COVID-19 Pandemic in Cardiac Catheterization Procedures for ST-Elevation Myocardial Infarction Across Ontario. CJC Open 2020; 2:678-683. [PMID: 32838257 PMCID: PMC7376355 DOI: 10.1016/j.cjco.2020.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/20/2020] [Indexed: 12/29/2022] Open
Abstract
Background In response to the COVID-19 pandemic, Ontario issued a declaration of emergency, implementing public health interventions on March 16, 2020. Methods We compared cardiac catheterization procedures for ST-elevation myocardial infarction (STEMI) between January 1 and May 10, 2020 to the same time frame in 2019. Results From March 16 to May 10, 2020, after implementation of provincial directives, STEMI cases significantly decreased by up to 25%. The proportion of patients who achieved guideline targets for first medical contact balloon for primary percutaneous coronary intervention (PCI) decreased substantially to 28% (median, 101 minutes) for patients who presented directly to a PCI site and to 37% (median, 149 minutes) for patients transferred from a non-PCI site, compared with 2019. Conclusions STEMI cases across Ontario have been substantially affected during the COVID-19 pandemic.
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Affiliation(s)
- Madhu K Natarajan
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Harindra C Wijeysundera
- Schulich Heart Center, Sunnybrook Health Sciences Center, University of Toronto, ICES Toronto, Toronto, Ontario, Canada
| | | | - Warren J Cantor
- Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Steven E S Miner
- Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Welsford
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sheldon Cheskes
- Department of Family Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michel R Le May
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Dennis T Ko
- Schulich Heart Center, Sunnybrook Health Sciences Center, University of Toronto, ICES Toronto, Toronto, Ontario, Canada
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Siripanthong B, Hanff TC, Levin MG, Vidula MK, Khanji MY, Nazarian S, Chahal CAA. Coronavirus disease 2019 is delaying the diagnosis and management of chest pain, acute coronary syndromes, myocarditis and heart failure. Future Cardiol 2020; 17:3-6. [PMID: 32608242 PMCID: PMC7328666 DOI: 10.2217/fca-2020-0088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
| | - Thomas C Hanff
- Division of Cardiovascular Medicine, Hospital of The University of Pennsylvania, PA 19104, USA
| | - Michael G Levin
- Division of Cardiovascular Medicine, Hospital of The University of Pennsylvania, PA 19104, USA
| | - Mahesh K Vidula
- Division of Cardiovascular Medicine, Hospital of The University of Pennsylvania, PA 19104, USA
| | - Mohammed Y Khanji
- Department of Cardiology, Newham University Hospital and Barts Heart Centre, Barts Health NHS Trust, London, E13 8SL, UK
| | - Saman Nazarian
- Division of Cardiovascular Medicine, Hospital of The University of Pennsylvania, PA 19104, USA
| | - Choudhary Anwar A Chahal
- Division of Cardiovascular Medicine, Hospital of The University of Pennsylvania, PA 19104, USA.,Mayo Clinic Rochester, MN 55905, United States.,Royal Papworth Hospital, NHS Trust, Cambridge, CB2 0AY, UK
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