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Management of Acute Myocardial Infarction During the COVID-19 Pandemic

Key Points:

  • Reassure public that safeguards are available to minimize patient exposure to COVID – 19 in the hospital setting.
  • Patients should continue to use the 911 EMS system for symptoms suggestive of acute ischemic symptoms suggesting a heart attack to assure appropriate care.
  • Adhere to optimal protection for medical personnel including PPE and masking patients.
  • Primary PCI is the standard of care for definite STEMI. After PCI of the culprit artery, PCI of other
  • In the setting of COVID – 19 presentations may be deceptive – thus a careful assessment before going to the cath lab is warranted for patients with diffuse ST – Segment Elevation which might represent acute myocarditis, coronary spasm or other non-traditional presentations which have been reported in COVID – 19 patients and represent cases in which primary thrombolytic treatment would have risk without benefit.
  • Patients with severe respiratory dysfunction consistent with ARDS requiring ventilation with multiple co-morbidities may be considered for supportive only care because of a high mortality risk
  • Thrombolytic therapy can be considered for patients seen at a non-PCI center unable to be transported to a Primary PCI Center within 120 minutes (current standard recommendation). If thrombolytic treatment is utilized, transfer to a PCI Center is recommended (current guideline) after a phone discussion with the potential accepting center.
  • Patients with Cardiogenic Shock and ST Elevation STEMI are considered for urgent invasive therapy and possible hemodynamic support with consideration for intubation before entering cath lab to reduce risk of viral spread with sudden cardiac arrest.
  • Patients without of hospital cardiac arrest (OHCA) should be considered for invasive management if they have elevated ST – Segments consistent with infarction and wall motion abnormalities on echocardiography.
  • Non-Acute STEMI patients with OHCA should only be considered if hemodynamically unstable.
  • NSTEMI should be managed medically unless hemodynamically unstable or have high risk characteristics – Grace Score > 140.
  • Safety remains of utmost importance – ideally with a designated cath lab (and negative pressure if available) for these patients and appropriate PPE for all involved.