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Chammas L, Yuan K, Little S, Roadknight G, Varnai KA, Chang SC, Sze S, Davies J, Tsui A, Salih H, Glampson B, Papadimitriou D, Mulla A, Woods K, O'Gallagher K, Shah AD, Williams B, Asselbergs FW, Mayer E, Lee R, Herbert C, Johnson T, Grant S, Curzen N, Shah AM, Perera D, Patel RS, Channon KM, Kaura A, Mayet J, Eyre DW, Squire I, Kharbanda R, Lewis A, Wijesurendra RS. Changes in the investigation and management of suspected myocardial infarction and injury during COVID-19: a multi-centre study using routinely collected healthcare data. Front Cardiovasc Med 2024; 11:1406608. [PMID: 38836064 PMCID: PMC11148217 DOI: 10.3389/fcvm.2024.1406608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/02/2024] [Indexed: 06/06/2024] Open
Abstract
Objective The COVID-19 pandemic was associated with a reduction in the incidence of myocardial infarction (MI) diagnosis, in part because patients were less likely to present to hospital. Whether changes in clinical decision making with respect to the investigation and management of patients with suspected MI also contributed to this phenomenon is unknown. Methods Multicentre retrospective cohort study in three UK centres contributing data to the National Institute for Health Research Health Informatics Collaborative. Patients presenting to the Emergency Department (ED) of these centres between 1st January 2020 and 1st September 2020 were included. Three time epochs within this period were defined based on the course of the first wave of the COVID-19 pandemic: pre-pandemic (epoch 1), lockdown (epoch 2), post-lockdown (epoch 3). Results During the study period, 10,670 unique patients attended the ED with chest pain or dyspnoea, of whom 6,928 were admitted. Despite fewer total ED attendances in epoch 2, patient presentations with dyspnoea were increased (p < 0.001), with greater likelihood of troponin testing in both chest pain (p = 0.001) and dyspnoea (p < 0.001). There was a dramatic reduction in elective and emergency cardiac procedures (both p < 0.001), and greater overall mortality of patients (p < 0.001), compared to the pre-pandemic period. Positive COVID-19 and/or troponin test results were associated with increased mortality (p < 0.001), though the temporal risk profile differed. Conclusions The first wave of the COVID-19 pandemic was associated with significant changes not just in presentation, but also the investigation, management, and outcomes of patients presenting with suspected myocardial injury or MI.
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Affiliation(s)
- Lara Chammas
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Kevin Yuan
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Stephanie Little
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Gail Roadknight
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Kinga A Varnai
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Shing Chan Chang
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Shirley Sze
- NIHR Biomedical Cardiovascular Research Centre, Glenfield Hospital, Leicester and the University of Leicester, Leicester, United Kingdom
| | - Jim Davies
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Andrew Tsui
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Hizni Salih
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Ben Glampson
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dimitri Papadimitriou
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Abdulrahim Mulla
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Kerrie Woods
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Kevin O'Gallagher
- NIHR King's Biomedical Research Centre, King's College London and King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Anoop D Shah
- NIHR University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Bryan Williams
- NIHR University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Folkert W Asselbergs
- NIHR University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Erik Mayer
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Richard Lee
- NIHR BRC at the Royal Marsden and Institute of Cancer Research, London, United Kingdom
| | - Christopher Herbert
- NIHR Leeds Clinical Research Facility, Leeds Teaching Hospitals Trust and University of Leeds, Leeds, United Kingdom
| | - Tom Johnson
- NIHR Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Stuart Grant
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust and the University of Manchester, Manchester, United Kingdom
| | - Nick Curzen
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Ajay M Shah
- NIHR King's Biomedical Research Centre, King's College London and King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Divaka Perera
- NIHR Guys & St Thomas' Hospital Clinical Research Facility, King's College Hospital, and King's College London British Heart Foundation Centre of Excellence, London, United Kingdom
| | - Riyaz S Patel
- NIHR University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Keith M Channon
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Amit Kaura
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jamil Mayet
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | - David W Eyre
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Iain Squire
- NIHR Biomedical Cardiovascular Research Centre, Glenfield Hospital, Leicester and the University of Leicester, Leicester, United Kingdom
| | - Raj Kharbanda
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Andrew Lewis
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rohan S Wijesurendra
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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Yang L, Wu Y, Jin W, Mo N, Ye G, Su Z, Tang L, Wang Y, Li Y, Du J. The potential role of ferroptosis in COVID-19-related cardiovascular injury. Biomed Pharmacother 2023; 168:115637. [PMID: 37844358 DOI: 10.1016/j.biopha.2023.115637] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged as a global health threat in 2019. An important feature of the disease is that multiorgan symptoms of SARS-CoV-2 infection persist after recovery. Evidence indicates that people who recovered from COVID-19, even those under the age of 65 years without cardiovascular risk factors such as smoking, obesity, hypertension, and diabetes, had a significantly increased risk of cardiovascular disease for up to one year after diagnosis. Therefore, it is important to closely monitor individuals who have recovered from COVID-19 for potential cardiovascular damage that may manifest at a later stage. Ferroptosis is an iron-dependent form of non-apoptotic cell death characterized by the production of reactive oxygen species (ROS) and increased lipid peroxide levels. Several studies have demonstrated that ferroptosis plays an important role in cancer, ischemia/reperfusion injury (I/RI), and other cardiovascular diseases. Altered iron metabolism, upregulation of reactive oxygen species, and glutathione peroxidase 4 inactivation are striking features of COVID-19-related cardiovascular injury. SARS-CoV-2 can cause cardiovascular ferroptosis, leading to cardiovascular damage. Understanding the mechanism of ferroptosis in COVID-19-related cardiovascular injuries will contribute to the development of treatment regimens for preventing or reducing COVID-19-related cardiovascular complications. In this article, we go over the pathophysiological underpinnings of SARS-CoV-2-induced acute and chronic cardiovascular injury, the function of ferroptosis, and prospective treatment approaches.
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Affiliation(s)
- Lei Yang
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China; Department of Central Laboratory, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yunyi Wu
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Weidong Jin
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Nan Mo
- Department of Central Laboratory, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Gaoqi Ye
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zixin Su
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Lusheng Tang
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Ying Wang
- Department of Central Laboratory, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| | - Yanchun Li
- Department of Central Laboratory, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| | - Jing Du
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
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Muhyieddeen A, Cheng S, Mamas MA, Beasley D, Weins GC, Gulati M. Racial Disparities in Mortality Associated With Acute Myocardial Infarction and COVID-19 in the United States: A Nationwide Analysis. Curr Probl Cardiol 2023; 48:101798. [PMID: 37178989 PMCID: PMC10174333 DOI: 10.1016/j.cpcardiol.2023.101798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Abstract
This study assessed the COVID-19 pandemic's impact on racial disparities in acute myocardial infarction (AMI) management and outcomes. We reviewed AMI patient management and outcomes in the pandemic's initial nine months, comparing COVID-19 and non-COVID-19 cases using 2020's National Inpatient Sample data. Our findings revealed that patients with concurrent AMI and COVID-19 had higher in-hospital mortality (aOR 3.19, 95% CI 2.63-3.88), increased mechanical ventilation (aOR 1.90, 95% CI 1.54-2.33), and higher initiation of hemodialysis (aOR 1.38, 95% CI 1.05-1.89) compared to those without COVID-19. Moreover, Black and Asian/Pacific Islander patients had higher in-hospital mortality than White patients, (aOR 2.13, 95% CI 1.35-3.59; aOR 3.41, 95% CI 1.5-8.37). Also, Black, Hispanic, and Asian/Pacific Islander patients showed higher odds of initiating hemodialysis (aOR 5.48, 95% CI 2.13-14.1; aOR 2.99, 95% CI 1.13-7.97; aOR 7.84, 95% CI 1.55-39.5), and were less likely to receive PCI for AMI (aOR 0.71, 95% CI 0.67-0.74; aOR 0.81, 95% CI 0.77-0.86; aOR 0.82, 95% CI 0.75-0.90). Black patients also showed less likelihood of undergoing CABG (aOR 0.55, 95% CI 0.49-0.61). Our study highlights elevated mortality and complications in COVID-19 AMI patients, emphasizing significant racial disparities. These findings underscore the pressing need for initiatives addressing healthcare disparities, enhancing access, and promoting culturally sensitive care to boost health equity.
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Affiliation(s)
- Amer Muhyieddeen
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles, CA
| | - Susan Cheng
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles, CA
| | - Mamas A Mamas
- Keele Cardiac Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | | | - Galen Cook Weins
- Bioststatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Martha Gulati
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles, CA.
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Thiele H, Zeymer U. The changing spectrum of cardiovascular emergencies during the COVID-19 pandemic. Herz 2023:10.1007/s00059-023-05174-6. [PMID: 37097477 PMCID: PMC10127984 DOI: 10.1007/s00059-023-05174-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 04/26/2023]
Abstract
The outbreak of the COVID-19 pandemic in March 2020 influenced treatment strategies and behaviors, particularly cardiovascular emergencies, which may have led to cardiovascular collateral damage. This review article covers aspects of the changing spectrum of cardiac emergencies with a focus on acute coronary syndrome rates and cardiovascular mortality and morbidity based on a selected literature review including the most recent comprehensive meta-analyses.
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Affiliation(s)
- Holger Thiele
- Heart Center Leipzig, Department of Internal Medicine/Cardiology, University of Leipzig, Strümpellstraße 39, 04289, Leipzig, Germany.
| | - Uwe Zeymer
- Institut für Herzinfarktforschung, Klinikum Ludwigshafen, Bremserstraße 79, 67063, Ludwigshafen, Germany
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5
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Abstract
PURPOSE OF REVIEW Cardiac consequences occur in both acute COVID-19 and post-acute sequelae of COVID-19 (PASC). Here, we highlight the current understanding about COVID-19 cardiac effects, based upon clinical, imaging, autopsy, and molecular studies. RECENT FINDINGS COVID-19 cardiac effects are heterogeneous. Multiple, concurrent cardiac histopathologic findings have been detected on autopsies of COVID-19 non-survivors. Microthrombi and cardiomyocyte necrosis are commonly detected. Macrophages often infiltrate the heart at high density but without fulfilling histologic criteria for myocarditis. The high prevalences of microthrombi and inflammatory infiltrates in fatal COVID-19 raise the concern that recovered COVID-19 patients may have similar but subclinical cardiac pathology. Molecular studies suggest that SARS-CoV-2 infection of cardiac pericytes, dysregulated immunothrombosis, and pro-inflammatory and anti-fibrinolytic responses underlie COVID-19 cardiac pathology. The extent and nature by which mild COVID-19 affects the heart is unknown. Imaging and epidemiologic studies of recovered COVID-19 patients suggest that even mild illness confers increased risks of cardiac inflammation, cardiovascular disorders, and cardiovascular death. The mechanistic details of COVID-19 cardiac pathophysiology remain under active investigation. The ongoing evolution of SARS-CoV-2 variants and vast numbers of recovered COVID-19 patients portend a burgeoning global cardiovascular disease burden. Our ability to prevent and treat cardiovascular disease in the future will likely depend on comprehensive understanding of COVID-19 cardiac pathophysiologic phenotypes.
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Affiliation(s)
- Lorenzo R. Sewanan
- Department of Medicine, Columbia University Irving Medical Center, New York, NY USA
| | - Kevin J. Clerkin
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia University Irving Medical Center, New York, NY USA
| | | | - Emily J. Tsai
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia University Irving Medical Center, New York, NY USA
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Mahabadi AA, Mincu R, Dykun I, Michel L, Küng A, Witzke O, Kill C, Buer J, Rassaf T, Totzeck M. Frequency and prognosis of CVD and myocardial injury in patients presenting with suspected COVID-19 - The CoV-COR registry. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VASCULATURE 2023; 45:101184. [PMID: 36776683 PMCID: PMC9899778 DOI: 10.1016/j.ijcha.2023.101184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023]
Abstract
Background The COVID-19 pandemic led to an alteration of algorithms in emergency medicine, which may influence the management of patients with similar symptoms but underlying cardiovascular diseases. We evaluated key differential diagnoses to acute COVID-19 infection and the prevalence and the prognosis of myocardial injury in patients presenting for suspected COIVD-19 infection. Methods This prospective observational study includes patients presenting with symptoms suggestive of COVID-19 infection during the pandemic. In patients without COVID-19, leading diagnoses was classified according to ICD-10. Myocardial injury was defined as elevated high-sensitivity Troponin I with at least one value above the 99th percentile upper reference limit and its prevalence together with 90-days mortality rate was compared in patients with vs without COVID-infection. Results From 497 included patients (age 62.9 ± 17.2 years, 56 % male), 314 (63 %) were tested positive on COVID-19 based on PCR-testing, while another cause of symptom was detected in 183 patients (37 %). Cardiovascular diseases were the most frequent differential diagnoses (40 % of patients without COVID-19), followed by bacterial infection (24 %) and malignancies (16 %). Myocardial injury was present in 91 patients (COVID-19 positive: n = 34, COVID-19 negative: n = 57). 90-day mortality rate was higher in patients with myocardial injury (13.4 vs 4.6 %, p = 0.009). Conclusion Cardiovascular diseases represent the most frequent differential diagnoses in patients presenting to a tertiary care emergency department with symptoms suggestive of an acute infection. Screening for cardiovascular disease is crucial in the initial evaluation of symptomatic patients during the COVID pandemic to identify patients at increased risk.Trial Registration:Clinicaltrials.gov Identifier: NCT04327479.
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Affiliation(s)
- Amir A. Mahabadi
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany,Corresponding author.
| | - Raluca Mincu
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Iryna Dykun
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Lars Michel
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Alexander Küng
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Clemens Kill
- Center of Emergency Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Jan Buer
- the Institute of Medical Microbiology, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Tienush Rassaf
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Matthias Totzeck
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
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Lopez-de-Andres A, Jimenez-Garcia R, Carabantes-Alarcon D, Hernández-Barrera V, de-Miguel-Yanes JM, de-Miguel-Diez J, Zamorano-Leon JJ, del-Barrio JL, Cuadrado-Corrales N. Use of Cardiac Procedures in People with Diabetes during the COVID Pandemic in Spain: Effects on the In-Hospital Mortality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:844. [PMID: 36613166 PMCID: PMC9819421 DOI: 10.3390/ijerph20010844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/16/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
We aimed to assess the effect of the COVID-19 pandemic in Spain on people with diabetes undergoing cardiac procedures, such as coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), open surgical valve replacement (OSVR), and transcatheter valve implantation (TCVI). We compared the year 2019 with the year 2020. We conducted an observational study using data from the Spanish National Hospital Discharge Database from 1 January 2019 to 31 December 2020. In 2020, a total of 21,067 cardiac procedures were performed on people with diabetes compared with 24,675 in the previous year. The use of CABG, PCI, OSVR and TCVI decreased from 2019 to 2020 by 13.9%, 14.8%, 21.4% and 2.9%, respectively. In 2020, patients had a significantly higher mean Charlson Comorbidity Index than in 2019 for all the cardiac procedures analyzed. In-hospital mortality (IHM) was higher (p > 0.05) for all the procedures in the year 2020. Over the entire period, female sex was a significant risk factor for IHM among those who underwent CABG, PCI and OSVR (OR 1.94, 95%CI 1.41-2.66; OR 1.19, 95%CI 1.05-1.35; and OR 1.79, 95%CI 1.38-2.32, respectively). The sensitivity analysis including two more years, 2017 and 2018, confirmed that female patients and comorbidity were risk factors for IHM in patients with diabetes regardless of whether it was during the pandemic era or before. We conclude that the frequency of cardiac procedures among people with diabetes declined in 2020. IHM did not change significantly in the COVID-19 era.
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Affiliation(s)
- Ana Lopez-de-Andres
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Rodrigo Jimenez-Garcia
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - David Carabantes-Alarcon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain
| | - José M. de-Miguel-Yanes
- Internal Medicine Department, Hospital General Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28007 Madrid, Spain
| | - Javier de-Miguel-Diez
- Respiratory Department, Hospital General Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28007 Madrid, Spain
| | - Jose J. Zamorano-Leon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Jose L. del-Barrio
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain
| | - Natividad Cuadrado-Corrales
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
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Roy R, McDonaugh B, O'Gallagher K. COVID-19 and the heart. Br Med Bull 2022; 144:4-11. [PMID: 36155748 PMCID: PMC9619476 DOI: 10.1093/bmb/ldac022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/26/2022] [Accepted: 09/02/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND There is evidence for a bi-directional relationship between COVID-19 and the cardiovascular (CV) system. SOURCE OF DATA Published literature. AREAS OF AGREEMENT Pre-existing heart failure (HF) increases the risk of mortality with COVID-19. CV complications are recognized, including increased rates of acute coronary syndromes, HF, arrhythmia and myocarditis. Drugs targeting the angiotensin system are safe and may provide prognostic benefit. AREAS OF CONTROVERSY Vaccination as a cause of myocarditis remains a key area of contention. GROWING POINTS As the pandemic progresses, we are gaining more data about the long-term effects of COVID-19 on the CV system: long COVID, and medium-to-long-term increases in CV risk. AREAS TIMELY FOR DEVELOPING RESEARCH Large-scale longitudinal studies will shed light on long-term CV outcomes with COVID-19. Furthermore, the differential effects of COVID-19 variants on the CV system must be investigated.
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Affiliation(s)
- Roman Roy
- Cardiovascular Department, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | | | - Kevin O'Gallagher
- Cardiovascular Department, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK.,British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London SE5 9NU, UK
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Ma J, Zhou S, Li N, Dong X, Maimaitiming M, Yue D, Jin Y, Zheng ZJ. Quality of healthcare and admission rates for acute cardiac events during COVID-19 pandemic: a retrospective cohort study on ST-segment-elevation myocardial infarction in China. BMJ Open 2022; 12:e059720. [PMID: 36357000 PMCID: PMC9659714 DOI: 10.1136/bmjopen-2021-059720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate changes in admission rates for and quality of healthcare of ST-segment-elevation myocardial infarction (STEMI) during the period of the COVID-19 outbreak and postoutbreak. METHODS We conducted a retrospective study among patients with STEMI in the outbreak time and the postoutbreak time. DESIGN To examine the changes in the admission rates and in quality of healthcare, by comparison between periods of the postoutbreak and the outbreak, and between the postoutbreak and the corresponding periods. SETTING Data for this analysis were included from patients discharge diagnosed with STEMI from all the hospitals of Suzhou in each month of the year until the end of July 2020. PARTICIPANTS 1965 STEMI admissions. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the number of moecondary outcomnthly STEMI admissions, and the secondary outcomes were the quality metrics of STEMI healthcare. RESULTS There were a 53% and 38% fall in daily admissions at the phase of outbreak and postoutbreak, compared with the 2019 corresponding. There remained a gap in actual number of postoutbreak admissions at 306 and the predicted number at 497, an estimated 26 deaths due to STEMI would have been caused by not seeking healthcare. Postoutbreak period of 2020 compared with corresponding period of 2019, the percentage of cases transferred by ambulance decreased from 9.3% to 4.2% (p=0.013), the door-to-balloon median time increased from 17.5 to 34.0 min (p=0.001) and the rate of percutaneous coronary intervention (PCI) therapy declined from 71.3% to 60.1% (p=0.002). CONCLUSIONS The impact of public health restrictions may lead to unexpected out-of-hospital deaths and compromised quality of healthcare for acute cardiac events. Delay or absence in patients should be continuously considered avoiding the secondary disaster of the pandemic. System delay should be modifiable for reversing the worst clinical outcomes from the COVID-19 outbreak, by coordination measures with focus on the balance between timely PCI procedure and minimising contamination of cardiac catheterisation rooms.
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Affiliation(s)
- Junxiong Ma
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Shuduo Zhou
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Na Li
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Xuejie Dong
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Mailikezhati Maimaitiming
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Dahai Yue
- Department of Health Policy and Management, University of Maryland at College Park, College Park, Maryland, USA
| | - Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
- Bill & Melinda Gates Foundation China Office, Beijing, China
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10
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Akinrinmade AO, Obitulata-Ugwu VO, Obijiofor NB, Victor F, Chive M, Marwizi FM, Odion-Omonhimin LO, Obasi NB. COVID-19 and Acute Coronary Syndrome: A Literature Review. Cureus 2022; 14:e29747. [PMID: 36324350 PMCID: PMC9617587 DOI: 10.7759/cureus.29747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 12/15/2022] Open
Abstract
The coronavirus disease 2019, also known as the COVID-19 pandemic has had a deleterious impact on daily living, with health and socioeconomic effects of a global magnitude. Acute coronary syndrome (ACS), an important cardiovascular disease with significant morbidity and mortality rates, has been frequently reported in patients with this novel virus. This review aims to discuss the potential associations between COVID-19 and ACS with the use of multiple databases, including but not limited to; PubMed, ScienceDirect, World Health Organization, and American Heart Association. We have explored the pathophysiology of ACS, focusing on COVID-19 in particular with the use of various works of literature that highlights the pattern of viral entry and replication via the angiotensin-converting enzyme II. The review has also discussed the impact of the pandemic on hospital admissions, diagnosis, and management of ACS patients, as well as briefly highlighted a possible link between the widely available COVID-19 vaccines and possible cardiovascular complications. The association between COVID-19 and ACS needs more in-depth studies to help establish whether there exists a direct causal and or inciting correlation between them. Understanding this association might lead to new research and treatment options for ACS patients.
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11
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Effect of COVID-19 pandemic on six-month mortality and clinical outcomes of patients with ST-elevation myocardial infarction. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2022; 18:228-236. [PMID: 36751282 PMCID: PMC9885228 DOI: 10.5114/aic.2022.122864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction The coronavirus disease 2019 (COVID-19) infection has changed everyday clinical practice, with a shortage of solid data about its implications for ST-elevation myocardial infarction (STEMI) patients. Aim To evaluate the impact of COVID-19 on 6-month clinical outcomes of patients with STEMI and determine the mortality predictors after STEMI during the COVID-19 pandemic. Material and methods This prospective observational study was conducted on consecutive STEMI patients who presented to our hospital between April and October 2021. A total of 74 COVID-19-positive patients were included in group I and compared to 148 COVID-19-negative patients (group II). We compared the two cohorts' rates of major adverse cardiovascular events (MACEs; composite of death from any cause, recurrent MI, target-vessel revascularization, and stroke) at 6 months. Results COVID-19 STEMI patients were more likely to present with angina equivalent symptoms, had higher Killip class at admission, and higher levels of high-sensitive cardiac troponin T and serum C-reactive protein. The 6-month rates of MACEs were significantly higher in STEMI patients with COVID-19 compared to non-COVID-19 patients (41.9% vs. 16.9%, respectively; p < 0.001) and were mainly due to higher in-hospital mortality (20.3% vs. 6.1%, respectively; p = 0.001). The independent predictors of 6-month mortality in STEMI patients during the COVID-19 pandemic were the absence of ST resolution, low systolic blood and higher Killip class on admission, presence of severe MR and atrial fibrillation, and anterior wall STEMI. Conclusions STEMI patients with superimposed COVID-19 infection had worse clinical outcomes, with almost three times higher in-hospital mortality and 6-month MACEs.
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12
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Ianniciello A, Attena E, Carpinella G, Uccello A, Mauro C, Russo V. Late Onset Occurrence of Concomitant Myocardial Infarction and Ischemic Stroke in Hospitalized COVID-19 Patient: A Case Report. Int J Gen Med 2022; 15:6621-6626. [PMID: 35996597 PMCID: PMC9392459 DOI: 10.2147/ijgm.s370297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/03/2022] [Indexed: 12/02/2022] Open
Abstract
We described the case of a 68-year-old COVID-19 patient with hypertension and dyslipidemia who discontinued the cardiovascular medications during hospitalization and experienced a late onset occurrence of concomitant ST-elevation myocardial infarction and ischemic stroke at resolution of SARS-CoV-2 pneumonia.
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Affiliation(s)
- Antonio Ianniciello
- Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Emilio Attena
- Cardiology Unit, Monaldi and Cotugno Hospital, Naples, Italy
| | | | - Ambra Uccello
- Cardiology Unit, Marcianise Hospital, Caserta Health Authority, Caserta, Italy
| | - Ciro Mauro
- Cardiology Unit, Cardarelli Hospital, Naples, Italy
| | - Vincenzo Russo
- Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
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13
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Alasnag M, Shah B, Botti G, Zaman S, Chieffo A. STEMIs and a Closer Look at MINOCA During the COVID-19 Pandemic. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100372. [PMID: 35795878 PMCID: PMC9117730 DOI: 10.1016/j.jscai.2022.100372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
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14
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Ferlini M, Castini D, Ferrante G, Marenzi G, Montorfano M, Savonitto S, D’Urbano M, Lettieri C, Cuccia C, Marino M, Visconti LO, Carugo S. Acute Coronary Syndromes and SARS-CoV-2 Infection: Results From an Observational Multicenter Registry During the Second Pandemic Spread in Lombardy. Front Cardiovasc Med 2022; 9:912815. [PMID: 35783857 PMCID: PMC9243433 DOI: 10.3389/fcvm.2022.912815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/24/2022] [Indexed: 12/29/2022] Open
Abstract
Background COVID-19 had an adverse impact on the management and outcome of acute coronary syndromes (ACS), but most available data refer to March-April 2020. Aim This study aims to investigate the clinical characteristics, time of treatment, and clinical outcome of patients at hospitals serving as macro-hubs during the second pandemic wave of SARS-CoV-2 (November 2020-January 2021). Methods and Results Nine out of thirteen “macro-hubs” agreed to participate in the registry with a total of 941 patients included. The median age was 67 years (IQR 58-77) and ST-elevation myocardial infarction (STEMI) was the clinical presentation in 54% of cases. Almost all patients (97%) underwent coronary angiography, with more than 60% of patients transported to a macro-hub by the Emergency Medical Service (EMS). In the whole population of STEMI patients, the median time from symptom onset to First Medical Contact (FMC) was 64 min (IQR 30-180). The median time from FMC to CathLab was 69 min (IQR 39-105). A total of 59 patients (6.3%) presented a concomitant confirmed SARS-CoV-2 infection, and pneumonia was present in 42.4% of these cases. No significant differences were found between STEMI patients with and without SARS-CoV-2 infection in treatment time intervals. Patients with concomitant SARS-CoV-2 infection had a significantly higher in-hospital mortality compared to those without (16.9% vs. 3.6%, P < 0.0001). However, post-discharge mortality was similar to 6-month mortality (4.2% vs. 4.1%, P = 0.98). In the multivariate analysis, SARS-CoV-2 infection did not show an independent association with in-hospital mortality, whereas pneumonia had higher mortality (OR 5.65, P = 0.05). Conclusion During the second wave of SARS-CoV-2 infection, almost all patients with ACS received coronary angiography for STEMI with an acceptable time delay. Patients with concomitant infection presented a lower in-hospital survival with no difference in post-discharge mortality; infection by itself was not an independent predictor of mortality but pneumonia was.
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Affiliation(s)
- Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Diego Castini
- Cardiology Department, ASST Santi Paolo e Carlo, Milan, Italy
| | - Giulia Ferrante
- Department of Clinical Sciences and Community Health, Division of Cardiology, University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giancarlo Marenzi
- IRCCS Centro Cardiologico Monzino, University of Milan, Milan, Italy
| | | | | | - Maurizio D’Urbano
- Cardiology Department, Legnano Hospital, ASST Ovest Milanese, Legnano, Italy
| | - Corrado Lettieri
- Cardiology Department, Carlo Poma Hospital, ASST Mantova, Mantua, Italy
| | - Claudio Cuccia
- Cardiology Department, Poliambulanza Hospital, Brescia, Italy
| | - Marcello Marino
- Cardiology Department, Ospedale Maggiore di Crema, ASST Crema, Crema, Italy
| | | | - Stefano Carugo
- Department of Clinical Sciences and Community Health, Division of Cardiology, University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- *Correspondence: Stefano Carugo,
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15
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Battaglini D, Lopes-Pacheco M, Castro-Faria-Neto HC, Pelosi P, Rocco PRM. Laboratory Biomarkers for Diagnosis and Prognosis in COVID-19. Front Immunol 2022; 13:857573. [PMID: 35572561 PMCID: PMC9091347 DOI: 10.3389/fimmu.2022.857573] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/31/2022] [Indexed: 01/08/2023] Open
Abstract
Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) causes a wide spectrum of clinical manifestations, with progression to multiorgan failure in the most severe cases. Several biomarkers can be altered in coronavirus disease 2019 (COVID-19), and they can be associated with diagnosis, prognosis, and outcomes. The most used biomarkers in COVID-19 include several proinflammatory cytokines, neuron-specific enolase (NSE), lactate dehydrogenase (LDH), aspartate transaminase (AST), neutrophil count, neutrophils-to-lymphocytes ratio, troponins, creatine kinase (MB), myoglobin, D-dimer, brain natriuretic peptide (BNP), and its N-terminal pro-hormone (NT-proBNP). Some of these biomarkers can be readily used to predict disease severity, hospitalization, intensive care unit (ICU) admission, and mortality, while others, such as metabolomic and proteomic analysis, have not yet translated to clinical practice. This narrative review aims to identify laboratory biomarkers that have shown significant diagnostic and prognostic value for risk stratification in COVID-19 and discuss the possible clinical application of novel analytic strategies, like metabolomics and proteomics. Future research should focus on identifying a limited but essential number of laboratory biomarkers to easily predict prognosis and outcome in severe COVID-19.
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Affiliation(s)
- Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS) for Oncology and Neuroscience, Genoa, Italy.,Department of Surgical Science and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Miquéias Lopes-Pacheco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS) for Oncology and Neuroscience, Genoa, Italy.,Department of Surgical Science and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,COVID-19 Virus Network from Brazilian Council for Scientific and Technological Development, Brasília, Brazil.,COVID-19 Virus Network from Foundation Carlos Chagas Filho Research Support of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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16
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Ferlini M, Castini D, Visconti LO, Carugo S. Acute coronary syndromes during the first and the second wave of COVID-19. Eur J Intern Med 2022; 99:109-111. [PMID: 35131161 PMCID: PMC8810345 DOI: 10.1016/j.ejim.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/01/2022] [Indexed: 12/16/2022]
Affiliation(s)
- Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Diego Castini
- Cardiology Department, University of Milan, ASST Santi Paolo e Carlo, Milano, Italy
| | | | - Stefano Carugo
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Milano, Italy
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17
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Bergmark BA, Mathenge N, Merlini PA, Lawrence-Wright MB, Giugliano RP. Acute coronary syndromes. Lancet 2022; 399:1347-1358. [PMID: 35367005 PMCID: PMC8970581 DOI: 10.1016/s0140-6736(21)02391-6] [Citation(s) in RCA: 102] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 12/14/2022]
Abstract
Although substantial progress has been made in the diagnosis and treatment of acute coronary syndromes, cardiovascular disease remains the leading cause of death globally, with nearly half of these deaths due to ischaemic heart disease. The broadening availability of high-sensitivity troponin assays has allowed for rapid rule-out algorithms in patients with suspected non-ST-segment elevated myocardial infarction (NSTEMI). Dual antiplatelet therapy is recommended for 12 months following an acute coronary syndrome in most patients, and additional secondary prevention measures including intensive lipid-lowering therapy (LDL-C <1·4 mmol/L), neurohormonal agents, and lifestyle modification, are crucial. The scientific evidence for diagnosis and management of acute coronary syndromes continues to evolve rapidly, including adapting to the COVID-19 pandemic, which has impacted all aspects of care. This Seminar provides a clinically relevant overview of the pathobiology, diagnosis, and management of acute coronary syndromes, and describes key scientific advances.
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Affiliation(s)
- Brian A Bergmark
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Njambi Mathenge
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Piera A Merlini
- 4th Division of Cardiology, Cardiocenter De Gasperis, ASST GOM Niguarda and Bicocca University, Milan, Italy
| | - Marilyn B Lawrence-Wright
- Division of Cardiology, Department of Medicine, The University of the West Indies at Mona, Kingston, Jamaica
| | - Robert P Giugliano
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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18
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Crea F. European Society of Cardiology guidance for the management of cardiovascular disease during the pandemic and a focus on long COVID. Eur Heart J 2022; 43:1017-1021. [DOI: 10.1093/eurheartj/ehac087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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19
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Onnis C, Muscogiuri G, Paolo Bassareo P, Cau R, Mannelli L, Cadeddu C, Suri JS, Cerrone G, Gerosa C, Sironi S, Faa G, Carriero A, Pontone G, Saba L. Non-invasive coronary imaging in patients with COVID-19: a narrative review. Eur J Radiol 2022; 149:110188. [PMID: 35180580 PMCID: PMC8805958 DOI: 10.1016/j.ejrad.2022.110188] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 12/14/2022]
Abstract
SARS-CoV-2 infection, responsible for COVID-19 outbreak, can cause cardiac complications, worsening outcome and prognosis. In particular, it can exacerbate any underlying cardiovascular condition, leading to atherosclerosis and increased plaque vulnerability, which may cause acute coronary syndrome. We review current knowledge on the mechanisms by which SARS-CoV-2 can trigger endothelial/myocardial damage and cause plaque formation, instability and deterioration. The aim of this review is to evaluate current non-invasive diagnostic techniques for coronary arteries evaluation in COVID-19 patients, such as coronary CT angiography and atherosclerotic plaque imaging, and their clinical implications. We also discuss the role of artificial intelligence, deep learning and radiomics in the context of coronary imaging in COVID-19 patients.
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20
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COVID-19-mediated patient delay caused increased total ischaemic time in ST-segment elevation myocardial infarction. Neth Heart J 2022; 30:96-105. [PMID: 35044627 PMCID: PMC8767528 DOI: 10.1007/s12471-021-01653-9] [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] [Accepted: 11/30/2021] [Indexed: 11/06/2022] Open
Abstract
Background The current study aimed to evaluate changes in treatment delay and outcome for ST-segment elevation myocardial infarction (STEMI) in the Netherlands during the first coronavirus disease 2019 (COVID-19) outbreak, thereby comparing regions with a high and low COVID-19 hospitalisation rate. Methods Clinical characteristics, STEMI timing variables, 30-day all-cause mortality and cardiovascular complications of all consecutive patients admitted for STEMI from 1 January to 30 June in 2020 and 2019 to six hospitals performing a high volume of percutaneous coronary interventions were collected retrospectively using data from the Netherlands Heart Registry, hospital records and ambulance report forms. Patient delay, pre-hospital delay and door-to-balloon time before and after the outbreak of COVID-19 were compared to the equivalent periods in 2019. Results A total of 2169 patients were included. During the outbreak median total treatment delay significantly increased (2 h 51 min vs 2 h 32 min; p = 0.043) due to an increased patient delay (1 h 20 min vs 1 h; p = 0.030) with more late presentations > 24 h (1.1% vs 0.3%) in 2020. This increase was particularly evident during the peak phase of COVID-19 in regions with a high COVID-19 hospitalisation rate. During the peak phase door-to-balloon time was shorter (38 min vs 43 min; p = 0.042) than in 2019. All-cause 30-day mortality was comparable in both time frames (7.8% vs 7.3%; p = 0.797). Conclusions During the outbreak of COVID-19 patient delay caused an increase in total ischaemic time for STEMI, with a more pronounced delay in high-endemic regions, stressing the importance of good patient education during comparable crisis situations. Supplementary Information The online version of this article (10.1007/s12471-021-01653-9) contains supplementary material, which is available to authorized users.
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21
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Ponde C, Jain D, Suresh M, Gunasekaran S, Mishra S, Alexander T, Nair T. Impact of COVID-19 pandemic induced lockdown on management of myocardial infarction: An Indian survey report from the experiences by 1083 cardiologists. JOURNAL OF CLINICAL AND PREVENTIVE CARDIOLOGY 2022. [DOI: 10.4103/jcpc.jcpc_55_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Al-Assaf O, Musa A, Azaza N, Wardeh R, Awad R. Acute coronary syndrome in COVID-19: Obstacles and management challenges. HAMDAN MEDICAL JOURNAL 2022. [DOI: 10.4103/hmj.hmj_32_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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23
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Eckner D, Hofmann EM, Ademaj F, Martinovic K, Vogt F, Becher PM, Schrage B, Westermann D, Pauschinger M. Differences in the Treatment of Acute Coronary Syndrome in the Pre-COVID and COVID Era: An Analysis from Two German High-Volume Centers. J Cardiovasc Dev Dis 2021; 8:145. [PMID: 34821698 PMCID: PMC8625826 DOI: 10.3390/jcdd8110145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/23/2021] [Accepted: 10/29/2021] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic is placing a heavy burden on healthcare systems worldwide with the risk that acute cardiovascular diseases are treated too late. The present study aims to analyze patients with acute coronary syndrome in the current pandemic. A total of 966 patients (2019 n = 463, 2020 n = 503) can be evaluated. A comparison of patient care during and before the COVID-19 pandemic was made in terms of patient characteristics and pre- and in-hospital processes. Another aim is to show how many patients seek clinical care at a late stage of the disease. After Lockdown in Germany at week 12, 2020, there was a significant decrease in patients with an acute coronary syndrome (ACS), significant for STEMI cases in the first weeks after Lockdown (calendar week 13-16 2019 n = 43, 2020 n = 30; p = 0.02). The time from pain to first medical contact (time to FMC) is significantly extended during Lockdown, while internal clinical processes are unchanged. The rate of subacute myocardial infarction is numerically, but not significantly increased in calendar weeks 15, 2020 (p = 0.40) and 16 (p = 0,19). In addition, elderly patients avoid treatment for multifactorial reasons, and the longer overall pain to FMC may impact long-term mortality.
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Affiliation(s)
- Dennis Eckner
- Department of Cardiology, Paracelsus Medical University, 90471 Nuremberg, Germany; (E.M.H.); (F.A.); (K.M.); (M.P.)
| | - Eva M. Hofmann
- Department of Cardiology, Paracelsus Medical University, 90471 Nuremberg, Germany; (E.M.H.); (F.A.); (K.M.); (M.P.)
| | - Fadil Ademaj
- Department of Cardiology, Paracelsus Medical University, 90471 Nuremberg, Germany; (E.M.H.); (F.A.); (K.M.); (M.P.)
| | - Kristinko Martinovic
- Department of Cardiology, Paracelsus Medical University, 90471 Nuremberg, Germany; (E.M.H.); (F.A.); (K.M.); (M.P.)
| | - Ferdinand Vogt
- Department of Cardiac Surgery, Paracelsus Medical University, 90419 Nuremberg, Germany;
- Department of Cardiac Surgery, Artemed Clinic Munich South, 81379 Munich, Germany
| | - Peter Moritz Becher
- Department of Cardiology, University Heart and Vascular Centre, 20251 Hamburg, Germany; (P.M.B.); (B.S.); (D.W.)
| | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Centre, 20251 Hamburg, Germany; (P.M.B.); (B.S.); (D.W.)
| | - Dirk Westermann
- Department of Cardiology, University Heart and Vascular Centre, 20251 Hamburg, Germany; (P.M.B.); (B.S.); (D.W.)
| | - Matthias Pauschinger
- Department of Cardiology, Paracelsus Medical University, 90471 Nuremberg, Germany; (E.M.H.); (F.A.); (K.M.); (M.P.)
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Mimoso J. [The impact of Covid-19 pandemic on acute coronary syndrome admissions in a tertiary care hospital in Portugal]. Rev Port Cardiol 2021; 41:153-154. [PMID: 34728893 PMCID: PMC8554073 DOI: 10.1016/j.repc.2021.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jorge Mimoso
- Serviço de Cardiologia, Centro Hospitalar e Universitário do Algarve, Faro, Portugal
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Matteucci A, Bonanni M, Versaci F, Frati G, Peruzzi M, Sangiorgi G, Biondi-Zoccai G, Massaro G. Cardiovascular medicine: a year in review. Minerva Cardiol Angiol 2021; 70:40-55. [PMID: 34713681 DOI: 10.23736/s2724-5683.21.05816-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Cardiovascular medicine is facing several challenges in the current era, dominated by the rapid spread of a previously unknown virus around the world. Indeed, the 2020 COVID-19 pandemic set the course of cardiovascular science and education in an extraordinary way, hogging the attention of the medical community. Notably, while COVID-19 impacted research progress, there has been considerable effort in exploring topics of great interest, from the management of acute coronary syndromes to new horizons in the treatment of heart failure, from novelties in the surgical treatment of cardiovascular disease to new data on implantable cardiac devices, and from new diagnostic applications of multimodal imaging techniques to relevant basic science findings. Minerva Cardiology and Angiology, formerly Minerva Cardioangiologica, has strived to inform its readers on these topics and novelties, aiming for a succinct yet poignant melding of timeliness and accuracy. Accordingly, the purpose of this narrative review is to highlight and summarize the major research and review articles published during 2020. In particular, we provide a broad overview of the novelties identifying six major areas of interest in the field of cardiovascular sciences in which new evidences have contributed to improving prevention, diagnosis and treatment of heart and vessels diseases.
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Affiliation(s)
- Andrea Matteucci
- Department of Experimental Medicine, Tor Vergata University of Rome, Rome, Italy -
| | - Michela Bonanni
- Department of Experimental Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Francesco Versaci
- UOC UTIC Emodinamica e Cardiologia, S. Maria Goretti Hospital, Latina, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.,IRCCS NEUROMED, Pozzilli, Isernia, Italy
| | - Mariangela Peruzzi
- Mediterranea Cardiocentro, Napoli, Italy.,Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Sangiorgi
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- IRCCS NEUROMED, Pozzilli, Isernia, Italy.,Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Gianluca Massaro
- Division of Cardiology, Tor Vergata University of Rome, Rome, Italy
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Fratta Pasini AM, Stranieri C, Girelli D, Busti F, Cominacini L. Is Ferroptosis a Key Component of the Process Leading to Multiorgan Damage in COVID-19? Antioxidants (Basel) 2021; 10:antiox10111677. [PMID: 34829548 PMCID: PMC8615234 DOI: 10.3390/antiox10111677] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 01/08/2023] Open
Abstract
Even though COVID-19 is mostly well-known for affecting respiratory pathology, it can also result in several extrapulmonary manifestations, leading to multiorgan damage. A recent reported case of SARS-CoV-2 myocarditis with cardiogenic shock showed a signature of myocardial and kidney ferroptosis, a novel, iron-dependent programmed cell death. The term ferroptosis was coined in the last decade to describe the form of cell death induced by the small molecule erastin. As a specific inducer of ferroptosis, erastin inhibits cystine-glutamate antiporter system Xc-, blocking transportation into the cytoplasm of cystine, a precursor of glutathione (GSH) in exchange with glutamate and the consequent malfunction of GPX4. Ferroptosis is also promoted by intracellular iron overload and by the iron-dependent accumulation of polyunsaturated fatty acids (PUFA)-derived lipid peroxides. Since depletion of GSH, inactivation of GPX4, altered iron metabolism, and upregulation of PUFA peroxidation by reactive oxygen species are peculiar signs of COVID-19, there is the possibility that SARS-CoV-2 may trigger ferroptosis in the cells of multiple organs, thus contributing to multiorgan damage. Here, we review the molecular mechanisms of ferroptosis and its possible relationship with SARS-CoV-2 infection and multiorgan damage. Finally, we analyze the potential interventions that may combat ferroptosis and, therefore, reduce multiorgan damage.
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Burger AL, Kaufmann CC, Jäger B, Pogran E, Ahmed A, Wojta J, Farhan S, Huber K. Direct cardiovascular complications and indirect collateral damage during the COVID-19 pandemic : A review. Wien Klin Wochenschr 2021; 133:1289-1297. [PMID: 34671829 PMCID: PMC8527966 DOI: 10.1007/s00508-021-01956-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/18/2021] [Indexed: 02/06/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), puts a heavy strain on healthcare systems around the globe with high numbers of infected patients. Pre-existing cardiovascular disease is a major risk factor for a severe clinical course of COVID-19 and is associated with adverse outcome. COVID-19 may directly exacerbate underlying heart disease and is frequently aggravated by cardiovascular complications, including arterial and venous thromboembolic events, malignant arrhythmia and myocardial injury. In addition to these direct cardiac manifestations of COVID-19, patients with cardiovascular disease face further indirect consequences of the pandemic, as the respective resources in the healthcare systems need to be redirected to cope with the high numbers of infected patients. Consecutively, a substantial decrease in cardiac procedures was reported during the pandemic with lower numbers of coronary angiographies and device implantations worldwide. As a consequence an increased number of out-of-hospital cardiac arrests, late-comers with subacute myocardial infarction and of patients presenting in cardiogenic shock or preshock were observed. Maintenance of high-quality cardiac care by avoiding a reduction of cardiac services is of utmost importance, especially in times of a pandemic.
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Affiliation(s)
- Achim Leo Burger
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Montleartstraße 37, 1160, Vienna, Austria.
| | - Christoph C Kaufmann
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Montleartstraße 37, 1160, Vienna, Austria
| | - Bernhard Jäger
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Montleartstraße 37, 1160, Vienna, Austria
| | - Edita Pogran
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Montleartstraße 37, 1160, Vienna, Austria
| | - Amro Ahmed
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Montleartstraße 37, 1160, Vienna, Austria
| | - Johann Wojta
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kurt Huber
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Montleartstraße 37, 1160, Vienna, Austria.,Medical School, Sigmund Freud University, Vienna, Austria
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Crea F. Thrombosis in peripheral artery disease and thrombotic thrombocytopenia after adenoviral COVID-19 vaccination. Eur Heart J 2021; 42:3995-3999. [PMID: 34649281 PMCID: PMC8524636 DOI: 10.1093/eurheartj/ehab712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Massaro G, Lecis D, Martuscelli E, Chiricolo G, Sangiorgi GM. Clinical Features and Management of COVID-19–Associated Hypercoagulability. Card Electrophysiol Clin 2021; 14:41-52. [PMID: 35221084 PMCID: PMC8556574 DOI: 10.1016/j.ccep.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Pellegrini D, Fiocca L, Pescetelli I, Canova P, Vassileva A, Faggi L, Senni M, Guagliumi G. Effect of Respiratory Impairment on the Outcomes of Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction and Coronavirus Disease-2019 (COVID-19). Circ J 2021; 85:1701-1707. [PMID: 33658444 DOI: 10.1253/circj.cj-20-1166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Coronavirus Disease-2019 (COVID-19) may impair outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The extent of this phenomenon and its mechanisms are unclear.Methods and Results:This study prospectively included 50 consecutive STEMI patients admitted to our center for primary percutaneous coronary intervention (PCI) at the peak of the Italian COVID-19 outbreak. At admission, a COVID-19 test was positive in 24 patients (48%), negative in 26 (52%). The primary endpoint was in-hospital all-cause mortality. Upon admission, COVID-19 subjects had lower PO2/FiO2 (169 [100-425] vs. 390 [302-477], P<0.01), more need for oxygen support (62.5% vs. 26.9%, P=0.02) and a higher rate of myocardial dysfunction (ejection fraction <30% in 45.8% vs. 19.2%, P=0.04). All patients underwent emergency angiography. In 12.5% of COVID-19 patients, no culprit lesions were detected, thus PCI was performed in 87.5% and 100% of COVID-19 positive and negative patients, respectively (P=0.10). Despite a higher rate of obstinate thrombosis in the COVID-19 group (47.6% vs. 11.5%, P<0.01), the PCI result was similar (TIMI 2-3 in 90.5% vs. 100%, P=0.19). In-hospital mortality was 41.7% and 3.8% in COVID-19 positive and negative patients, respectively (P<0.01). Respiratory failure was the leading cause of death (80%) in the COVID-19 group, frequently associated with severe myocardial dysfunction. CONCLUSIONS In-hospital mortality of COVID-19 patients with STEMI remains high despite successful PCI, mainly due to coexisting severe respiratory failure. This may be a critical factor in patient management and treatment selection.
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Affiliation(s)
| | - Luigi Fiocca
- Cardiovascular Department, Papa Giovanni XXIII Hospital
| | | | - Paolo Canova
- Cardiovascular Department, Papa Giovanni XXIII Hospital
| | | | - Lara Faggi
- Cardiovascular Department, Papa Giovanni XXIII Hospital
| | - Michele Senni
- Cardiovascular Department, Papa Giovanni XXIII Hospital
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Firman D, Mangkuanom AS, Iryuza N, Fahri I, Artha IMJR, Mulia E, Syukri M, Yonas E, Pranata R, Alkatiri AA. Decrease in the Number of Patients Presenting With ST-Segment Elevation Myocardial Infarction Across Catheterization Centers in Indonesia During the Coronavirus Disease 2019 Pandemic. Front Cardiovasc Med 2021; 8:676592. [PMID: 34490361 PMCID: PMC8418056 DOI: 10.3389/fcvm.2021.676592] [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] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has become a global problem, put a heavy burden on the health care system, and resulted in many fatalities across the globe. A reduction in the number of cardiac emergencies, especially ST-segment elevation myocardial infarction (STEMI), is observed worldwide. In this study, we aimed to analyze the trends of cases and presentation of STEMI across several cardiac catheterization centers in Indonesia. Method: This retrospective study was performed by combining medical record data from five different hospitals in Indonesia. We compared data from the time period between February to June 2019 with those between February and June 2020. Patients who were diagnosed with STEMI and underwent primary percutaneous coronary intervention (PPCI) procedures were included in the study. Results: There were 41,396 emergency department visits in 2019 compared with 29,542 in 2020. The number of patients with STEMI declined significantly from 338 in 2019 to 190 in 2020. Moreover, the total number of PPCI procedures reduced from 217 in 2019 to 110 in 2020. The proportion of PPCI was not significantly reduced (64.2 vs. 57.9%). The majority of the patients were men, with a mean age of 54 years in 2019 and 55 years in 2020. We observed a significantly longer door-to-balloon time in 2020 than in 2019 (p < 0.001). We also observed a difference in the door-to-balloon time and ischemic time between the two periods. Conclusion: We observed a decline in the number of patients presenting with STEMI to our centers. However, we observed no significant decline in the percentage of PPCI performed across our centers during this pandemic.
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Affiliation(s)
- Doni Firman
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Arwin Saleh Mangkuanom
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Nanda Iryuza
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Ismir Fahri
- Department of Cardiology and Vascular Medicine, Mohammad Yunus General Hospital, Bengkulu, Indonesia
| | - I Made Junior Rina Artha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Indonesia
| | - Erwin Mulia
- Department of Cardiology and Vascular Medicine, Bumi Waras Hospital, Lampung, Indonesia
| | - Muhammad Syukri
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Andalas, DR. M. Djamil General Hospital, Padang, Indonesia
| | - Emir Yonas
- Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia
| | - Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Banten, Indonesia
| | - Amir Aziz Alkatiri
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Denegri A, Pezzuto G, D'Arienzo M, Morelli M, Savorani F, Cappello CG, Luciani A, Boriani G. Clinical and electrocardiographic characteristics at admission of COVID-19/SARS-CoV2 pneumonia infection. Intern Emerg Med 2021; 16:1451-1456. [PMID: 33398608 PMCID: PMC7781180 DOI: 10.1007/s11739-020-02578-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim of the present study was to compare clinical and electrocardiographic characteristics of patients with COVID-19 pneumonia in Modena, Emilia Romagna, Italy. METHODS Patients admitted to the emergency department for suspected COVID-19 pneumonia from March the 16th to April the 15th were enrolled in the study. COVID-19 pneumonia was confirmed by positive nasopharyngeal swab. Primary endpoint was 30-day mortality. RESULTS 201 patients were diagnosed with COVID-19 pneumonia. Compared to survivors, patients who died were older (79.7 ± 10.8 vs 65.6 ± 14.1, p < 0.001), with a more complex cardiovascular history, including coronary artery disease (CAD, 33.3% vs 13.3%, p = 0.004), atrial fibrillation (23.8 vs 8.8, p = 0.011) and chronic kidney disease (CKD 35.7% vs 7.0%, p < 0.001). 30-day mortality was 20,9% in these patients; atrial fibrillation (OR 12.74, 95% CI 3.65-44.48, p < 0.001), ST-segment depression (OR 5.30, 95% CI 1.50-18.81, p = 0.010) and QTc-interval prolongation (OR 3.17, 95% CI 1.24-8.10, p = 0.016) at ECG admission were associated to an increased mortality risk. On the contrary, sinus rhythm (OR 0.08, 95% CI 0.02-0.27, p < 0.001) and low-molecular weight heparin (LMWH) administration (OR 0.08, 95% CI 0.02-0.29, p < 0.001) were related to reduced mortality. At multivariate analysis, after adjustment for age, sex, diabetes, CAD, and MCA admission, sinus rhythm (HR 2.7, CI 95% 1.1-7.0, p = 0.038) and LMWH (HR 8.5, 95% CI 2.0-36.6, p = 0.004) were confirmed to be independent predictors of increased survival. CONCLUSION Sinus rhythm at ECG admission in COVID-19 pneumonia patients was associated with greater survival as well as LMWH administration, which conferred an overall better outcome.
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Affiliation(s)
- Andrea Denegri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy.
| | - Giuseppe Pezzuto
- Emergency Department, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Matteo D'Arienzo
- Emergency Department, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Marianna Morelli
- Emergency Department, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Fulvio Savorani
- Emergency Department, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Carlo G Cappello
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Antonio Luciani
- Emergency Department, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
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Crea F. Pulmonary embolism, COVID, and bleeding risk in acute coronary syndromes: a Focus Issue on thrombosis and antithrombotic treatment. Eur Heart J 2021; 42:3109-3113. [PMID: 34467397 DOI: 10.1093/eurheartj/ehab576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Vrachatis DA, Deftereos SG, Lansky A. Heroes, politics and media: the unshakable medical practice in the pandemic. Eur Heart J 2021; 42:2622-2625. [PMID: 33647950 DOI: 10.1093/eurheartj/ehab101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dimitrios A Vrachatis
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, 1 Rimini, Chaidari, 124 62 Athens, Greece
| | - Spyridon G Deftereos
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, 1 Rimini, Chaidari, 124 62 Athens, Greece
| | - Alexandra Lansky
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Shahabi J, Askari M, Azhari A, Kermani‐Alghoraishi M. The survey of electrophysiology lab activity during the COVID-19 pandemic. J Arrhythm 2021; 37:899-903. [PMID: 34386115 PMCID: PMC8339103 DOI: 10.1002/joa3.12584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 05/04/2021] [Accepted: 06/04/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND With the onset and spread of the COVID-19 pandemic, the hospitalization and treatment of noncovid patients were dramatically affected. The aim of this study is to evaluate the electrophysiology (EP) lab activity in a referral center in Iran during the COVID-19 era. METHODS A cross-sectional descriptive survey was conducted on EP lab activity in Shahid Chamran Heart Center, Isfahan, Iran. Two periods of COVID-19 occurrence peaks in Iran were compared with same date in 2019. Information was collected on number of diagnostic and therapeutic electrophysiology studies (EPSs) and implantation of intracardiac devices such as permanent pacemaker (PPM), implantable cardioverter defibrillator (ICD), and cardiac resynchronization therapy (CRT). RESULTS In the first peak of COVID-19 pandemic, both of EPSs and intracardiac device implantations decreased by 80% compared to the same period in 2019. The most common type of device implanted during this period was PPM (70%); however, at the time of control, the ICD (73%) was the most common. Paroxysmal supraventricular tachyarrhythmia (PSVT) was the best indication for diagnostic and therapeutic EPSs in covid and control periods. In the second peak of prevalence of COVID-19 virus infection in Iran, 6% and 36% decreases in device implantations and EPSs were seen, respectively. During this period, the number of procedures increased, although it was still lower than in 2019. CONCLUSION A significant reduction in the EP lab activity has been observed during both the COVID-19 pandemic peaks.
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Affiliation(s)
- Javad Shahabi
- Interventional Cardiology Research CenterCardiovascular Research InstituteIsfahan University of Medical SciencesIsfahanIran
| | - Mozhde Askari
- Interventional Cardiology Research CenterCardiovascular Research InstituteIsfahan University of Medical SciencesIsfahanIran
| | - Amirhossein Azhari
- Hypertension Research CenterCardiovascular Research InstituteIsfahan University of Medical SciencesIsfahanIran
| | - Mohammad Kermani‐Alghoraishi
- Interventional Cardiology Research CenterCardiovascular Research InstituteIsfahan University of Medical SciencesIsfahanIran
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36
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Montero-Cabezas JM, Córdoba-Soriano JG, Díez-Delhoyo F, Abellán-Huerta J, Girgis H, Rama-Merchán JC, García-Blas S, van Rees JB, van Ramshorst J, Jurado-Román A. Angiographic and Clinical Profile of Patients With COVID-19 Referred for Coronary Angiography During SARS-CoV-2 Outbreak: Results From a Collaborative, European, Multicenter Registry. Angiology 2021; 73:112-119. [PMID: 34318686 DOI: 10.1177/00033197211028760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Data regarding angiographic characteristics, clinical profile, and inhospital outcomes of patients with coronavirus disease 2019 (COVID-19) referred for coronary angiography (CAG) are scarce. This is an observational study analyzing confirmed patients with COVID-19 referred for CAG from 10 European centers. We included 57 patients (mean age: 66 ± 15 years, 82% male) , of whom 18% had previous myocardial infarction (MI) and 29% had renal insufficiency and chronic pulmonary disease. ST-segment elevation myocardial infarction (STEMI) was the most frequent indication for CAG (58%). Coronavirus disease 2019 was confirmed after CAG in 86% and classified as mild in 49%, with 21% fully asymptomatic. A culprit lesion was identified in 79% and high thrombus burden in 42%; 7% had stent thrombosis. At 40 days follow-up, 16 (28%) patients experienced a major adverse cardiovascular event (MACE): 12 deaths (92% noncardiac), 1 MI, 2 stent thrombosis, and 1 stroke. In an European multicenter registry, patients with confirmed COVID-19 infection referred for CAG during the first wave of the severe acute respiratory syndrome coronavirus 2 pandemic presented mostly with STEMI and were predominantly males with comorbidities. Severity of COVID-19 was in general noncritical and 21% were asymptomatic at the time of CAG. Culprit coronary lesions with high thrombus burden were frequently identified, with a rate of stent thrombosis of 7%. The incidence of MACE at 40 days was high (28%), mostly due to noncardiac death.
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Affiliation(s)
- J M Montero-Cabezas
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - J G Córdoba-Soriano
- Department of Cardiology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - F Díez-Delhoyo
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J Abellán-Huerta
- Department of Cardiology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - H Girgis
- Department of Cardiology, Jeroen Bosch Hospital. 's-Hertogenbosch, the Netherlands
| | | | - S García-Blas
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - J B van Rees
- Department of Cardiology, Rijnstate Hospital, Arnhem, the Netherlands
| | - J van Ramshorst
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - A Jurado-Román
- Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
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Saeed S, Tadic M, Larsen TH, Grassi G, Mancia G. Coronavirus disease 2019 and cardiovascular complications: focused clinical review. J Hypertens 2021; 39:1282-1292. [PMID: 33687179 PMCID: PMC9904438 DOI: 10.1097/hjh.0000000000002819] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/06/2021] [Accepted: 01/17/2021] [Indexed: 02/06/2023]
Abstract
The coronavirus disease 2019 (COVID-19) may cause not only an acute respiratory distress syndrome (ARDS) but also multiple organ damage and failure requiring intensive care and leading to death. Male sex, advanced age, chronic lung disease, chronic kidney disease and cardiovascular disease, such as hypertension, diabetes and obesity have been identified as risk factors for the COVID-19 severity. Presumably, as these three cardiovascular risk factors are associated with a high prevalence of multiorgan damage. In the present focused clinical review, we will discuss the cardiovascular complications of COVID-19 including acute cardiovascular syndrome (acute cardiac injury/COVID cardiomyopathy, thromboembolic complications and arrhythmias) and post-COVID-19 sequelae. Preliminary data shows that the cause of acute cardiovascular syndrome may be multifactorial and involve direct viral invasion of the heart and vascular system, as well as through the immune and inflammation-mediated systemic cytokine storm. COVID-19 survivors may also show persistently elevated blood pressure and sinus tachycardia at rest. Furthermore, poor diabetic control, persistent renal damage and cerebral sequelae, such as persistent cognitive and neuropsychiatric alterations are also frequently reported. A particular attention should be paid towards cardiovascular protection in COVID-19 patients who develop acute cardiovascular syndromes during hospitalization, and/or permanent/semipermanent sequelae after recovery from COVID-19. These conditions may require careful clinical assessment, treatment and close follow-up to avoid short-term and long-term complications.
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Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Marijana Tadic
- Department of Cardiology, University Hospital ‘Dr Dragisa Misovic-Dedinje’, Belgrade, Serbia
| | - Terje H. Larsen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan
| | - Giuseppe Mancia
- University of Milano-Bicocca, Milano and Policlinico di Monza, Monza, Italy
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38
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Affiliation(s)
- Kurt Huber
- 3rd Department of Internal Medicine, Cardiology and Intensive Care Unit, Wilhelminenhospital and Sigmund Freud University, Medical School, Vienna, Austria
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39
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Crea F. The central role of amygdala in stress-related cardiac diseases and an update on long-COVID. Eur Heart J 2021; 42:1813-1817. [PMID: 33990122 DOI: 10.1093/eurheartj/ehab255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Ibanez B, Roque D, Price S. The year in cardiovascular medicine 2020: acute coronary syndromes and intensive cardiac care. Eur Heart J 2021; 42:884-895. [PMID: 33388774 DOI: 10.1093/eurheartj/ehaa1090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/07/2020] [Accepted: 12/17/2020] [Indexed: 12/21/2022] Open
Affiliation(s)
- Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,Cardiology Department, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain.,CIBERCV, Madrid, Spain
| | - David Roque
- Cardiology Department, Prof. Dr. Fernando Fonseca Hospital, Amadora, Portugal
| | - Susanna Price
- Department of Cardiology and Department of Adult Critical Care, Royal Brompton Hospital, London, UK
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41
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Saeed S, Rajani R. The cardiovascular complications in COVID-19: Focus on acute cardiac injury. Pak J Med Sci 2021; 37:908-912. [PMID: 34104187 PMCID: PMC8155435 DOI: 10.12669/pjms.37.3.4063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/28/2021] [Indexed: 12/17/2022] Open
Abstract
At the end of 2019 a novel coronavirus was identified in Wuhan, China. The disease caused by the severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) was designated COVID-19 (corona virus disease 2019) by the World Health Organization in early 2020. Up to 80% of patients with COVID-19 experience mild symptoms with severe or critical disease occurring in the remaining 20%. Severe disease is manifested by the development of pneumonia, hypoxia and radiographic lung involvement while critical disease indicates multiorgan involvement with significant respiratory or cardiac compromise. The current estimated case fatality rate from COVID-19 is approximately 1%. Epidemiological studies have shown that advanced age, male gender, previous chronic lung disease, cardiovascular and kidney disease, obesity and diabetes are risk factors for the severity of disease course. In the current focused review, we present an overview of the acute cardiovascular complications of COVID-19, their detection and impact upon prognosis.
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Affiliation(s)
- Sahrai Saeed
- Sahrai Saeed, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Ronak Rajani
- Ronak Rajani Cardiothoracic Centre, Guy’s & St Thomas’ NHS Foundation Trust, London, United Kingdom. School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom
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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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Turgay Yıldırım Ö, Ayyildiz A. Comment on: Myocarditis, paraparesia and ARDS associated to COVID-19 infection". Heart Lung 2021; 50:575-576. [PMID: 33827763 PMCID: PMC7908878 DOI: 10.1016/j.hrtlng.2021.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 11/15/2022]
Affiliation(s)
| | - Ayşe Ayyildiz
- Eskişehir Osmangazi University, Department of Anaesthesiology and Reanimation, Eskisehir, Turkey
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Lemos PA, Franken M, Mariani J, Pitta FG, Oliveira FA, Cunha-Lima G, Caixeta AM, Almeida BO, Garcia RG. Use of robotic assistance to reduce proximity and air-sharing during percutaneous cardiovascular intervention. Future Cardiol 2021; 17:865-873. [PMID: 33834847 DOI: 10.2217/fca-2021-0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Traditional percutaneous cardiovascular interventions require close physical proximity between the patients and the healthcare team, posing occupational hazards that range from radiation exposure to interpersonal air contamination. Materials & methods: Prospective single-arm pilot study (n = 10) to investigate robotic-assisted intervention as a strategy to reduce proximity during the procedure. Primary end point: composite of angiographic success, intervention performed with the team positioned >2 meters from the patient for ≥50% procedure duration, and absence of in-hospital death or acute target lesion occlusion. Results: The composite primary end point was achieved in 100% of cases. Conclusion: Robotic-assisted percutaneous intervention provided successful invasive treatment while reducing proximity and shared air space between the care-delivery team and the patient during the procedure. Trial registration number: NCT04379453 (Clinicaltrials.gov).
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Affiliation(s)
- Pedro A Lemos
- Hospital Israelita Albert Einstein, Sao Paulo-SP, Brazil
| | | | - Jose Mariani
- Hospital Israelita Albert Einstein, Sao Paulo-SP, Brazil
| | - Fabio G Pitta
- Hospital Israelita Albert Einstein, Sao Paulo-SP, Brazil
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Turgay Yıldırım Ö, Yıldız G, Yıldırım S. Conflict in troponin levels in COVID-19 patients. Am J Emerg Med 2021; 43:249. [PMID: 33785237 PMCID: PMC7989100 DOI: 10.1016/j.ajem.2021.03.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Göknur Yıldız
- Eskisehir City Hospital, Department of Emergency Medicine, Eskisehir, Turkey
| | - Selim Yıldırım
- Anadolu University, Faculty of Economics and Administrative Sciences, Department of Economics, Eskisehir, Turkey; Eskisehir Technical University, Graduate School of Sciences, Statistics Department, Eskisehir, Turkey
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Rodriguez-Ramos MA. Effect of COVID-19 Pandemic on Performance Measures in Acute Myocardial Infarction. ACTA ACUST UNITED AC 2021; 61:52-56. [PMID: 33849419 DOI: 10.18087/cardio.2021.3.n1496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/15/2021] [Accepted: 02/16/2021] [Indexed: 11/18/2022]
Abstract
Objective To assess performance measures of attention of STEMI in Coronary Intensive Care Unit in General Hospital Camilo Cienfuegos.Methods Admitted patients with STEMI, from February-April 2020, were compared with patients from similar period from 2015-2019, and patients from January 2019 to January 2020. Primary endpoint were performance measures according to the 2017 AHA / ACC Clinical Performance and Quality Measures for Adults with STEMI document, and secondary endpoint were all-cause in-hospital mortality and major acute coronary events.Results Only 35 patients were admitted from February-April 2020. When comparing with similar periods from recent years, in-hospital death (8.3 % vs. 20 %; p=0.03), major complications (38.7 % vs. 57.1 %; p=0.03), and cardiogenic shock (6.9 % vs. 17.4 %; p=0.04) were significantly higher. When comparing with 2019 and January 2020, in-hospital death (9.6 %; p=0.04), and major complications (35.8 % p=0.03) were significantly higher in February-April 2020; however, there was no difference in prevalence of cardiogenic shock (8 %; p=0.12).Conclusion COVID-19 pandemic had decreased prevalence of STEMI, as well as some performance measures of attention in this center.
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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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The Number of Patients with Acute Myocardial Infarction Decreased and Door-to-Balloon Time Delayed in COVID-19. Cardiol Res Pract 2021; 2021:6673313. [PMID: 33791126 PMCID: PMC7996045 DOI: 10.1155/2021/6673313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/21/2021] [Accepted: 02/20/2021] [Indexed: 12/19/2022] Open
Abstract
Background At present, COVID-19 is sweeping the world, and all countries are actively responding. During the COVID-19 epidemic, the treatment of patients with acute myocardial infarction (AMI) may be affected. Methods We reviewed data of patients with AMI from January 23 to April 23, 2020 (2020), and January 23 to April 23, 2019 (2019), who were admitted to two hospitals from Southern China. We collected clinical characteristics, comorbidities, treatment, prognosis, and key time segments to analyze. Results The total number of patients that had been diagnosed with AMI in the two hospitals was 218 in 2020 and 260 in 2019. The number of AMI patients that were admitted to hospitals per day decreased in 2020. The percentage of patients with AMI who refused hospitalization in 2020 was significantly higher than that in 2019 (5.0% vs 1.5%, p=0.028). There is no statistical difference in symptoms of the first medical contact (S2FMC) time between 2020 and 2019 (p=0.552). Door-to-balloon (D2B) time of ST-elevation myocardial infarction (STEMI) patients who were treated with a primary percutaneous coronary intervention (pPCI) in 2020 was 79 (63.75-105.25) mins, while D2B time in 2019 was 57.5 (41.5-76.5) mins, which was statistically different from the two groups. Conclusions COVID-19 had an impact on the number of AMI patients who were admitted to hospitals and the time of treatment. During the COVID-19 epidemic, the number of AMI patients that were admitted to hospitals per day was decreased, while the percentage of AMI patients that refused therapy in these two hospitals increased, and the D2B time of STEMI patients was also delayed.
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Impact of diabetes in patients waiting for invasive cardiac procedures during COVID-19 pandemic. Cardiovasc Diabetol 2021; 20:69. [PMID: 33757510 PMCID: PMC7986134 DOI: 10.1186/s12933-021-01261-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/13/2021] [Indexed: 11/12/2022] Open
Abstract
Background During COVID-19 pandemic, elective invasive cardiac procedures (ICP) have been frequently cancelled or postponed. Consequences may be more evident in patients with diabetes. Objectives The objective was to identify the peculiarities of patients with DM among those in whom ICP were cancelled or postponed due to the COVID-19 pandemic, as well as to identify subgroups in which the influence of DM has higher impact on the clinical outcome. Methods We included 2,158 patients in whom an elective ICP was cancelled or postponed during COVID-19 pandemic in 37 hospitals in Spain. Among them, 700 (32.4%) were diabetics. Patients with and without diabetes were compared. Results Patients with diabetes were older and had a higher prevalence of other cardiovascular risk factors, previous cardiovascular history and co-morbidities. Diabetics had a higher mortality (3.0% vs. 1.0%; p = 0.001) and cardiovascular mortality (1.9% vs. 0.4%; p = 0.001). Differences were especially important in patients with valvular heart disease (mortality 6.9% vs 1.7% [p < 0.001] and cardiovascular mortality 4.9% vs 0.9% [p = 0.002] in patients with and without diabetes, respectively). In the multivariable analysis, diabetes remained as an independent risk factor both for overall and cardiovascular mortality. No significant interaction was found with other clinical variables. Conclusion Among patients in whom an elective invasive cardiac procedure is cancelled or postponed during COVID-19 pandemic, mortality and cardiovascular mortality is higher in patients with diabetes, irrespectively on other clinical conditions. These procedures should not be cancelled in patients with diabetes.
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Ikari Y, Yamada S, Ehara N, Kozuma K, Shinke T, Sugano T, Seike F, Sonoda S, Tazaki J, Tsuji T, Mibiki Y, Muramatsu T, Morita T, Sawano M. The Japanese Association of Cardiovascular Intervention and Therapeutics position statement on coronary invasive procedures during the COVID-19 pandemic in Japan. Cardiovasc Interv Ther 2021; 36:139-144. [PMID: 33748929 PMCID: PMC7982308 DOI: 10.1007/s12928-021-00767-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 10/31/2022]
Affiliation(s)
- Yuji Ikari
- The Japanese Association of Cardiovascular Intervention and Therapeutics, Tokyo, Japan.
| | - Shinichiro Yamada
- COVID-19 Task Force Subcommittee in Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT), Tokyo, Japan
| | - Natsuhiko Ehara
- COVID-19 Task Force Subcommittee in Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT), Tokyo, Japan
| | - Ken Kozuma
- COVID-19 Task Force Subcommittee in Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT), Tokyo, Japan
| | - Toshiro Shinke
- COVID-19 Task Force Subcommittee in Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT), Tokyo, Japan
| | - Teruyasu Sugano
- COVID-19 Task Force Subcommittee in Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT), Tokyo, Japan
| | - Fumiyasu Seike
- COVID-19 Task Force Subcommittee in Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT), Tokyo, Japan
| | - Shinjyo Sonoda
- COVID-19 Task Force Subcommittee in Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT), Tokyo, Japan
| | - Junichi Tazaki
- COVID-19 Task Force Subcommittee in Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT), Tokyo, Japan
| | - Takafumi Tsuji
- COVID-19 Task Force Subcommittee in Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT), Tokyo, Japan
| | - Yoshiaki Mibiki
- COVID-19 Task Force Subcommittee in Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT), Tokyo, Japan
| | - Takashi Muramatsu
- COVID-19 Task Force Subcommittee in Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT), Tokyo, Japan
| | - Takashi Morita
- COVID-19 Task Force Subcommittee in Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT), Tokyo, Japan
| | - Mitsuaki Sawano
- COVID-19 Task Force Subcommittee in Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT), Tokyo, Japan
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