Author + information
- Published online September 7, 2020.
- Ehtisham Mahmud, MD, FACC, FSCAIa,∗ (, )
- Harold L. Dauerman, MD, FACC, FSCAIb,
- Frederick G.P. Welt, MD, FACC, FSCAIc,
- John C. Messenger, MD, FACC, FSCAId,
- Sunil V. Rao, MD, FACC, FSCAIe,
- Cindy Grines, MD, FACC, MSCAIf,
- Amal Mattu, MD, FACEPg,
- Ajay J. Kirtane, MD, SM, FACC, FSCAIh,
- Rajiv Jauhar, MD, FACC, FSCAIi,
- Perwaiz Meraj, MD, FACC, FSCAIj,
- Ivan C. Rokos, MD, FACEPk,
- John S. Rumsfeld, MD, PhD, FACCl and
- Timothy D. Henry, MD, FACC, MSCAIm
- aSulpizio Cardiovascular Center, University of California-San Diego, La Jolla, California
- bUniversity of Vermont, Burlington, Vermont
- cUniversity of Utah Medical Center, Salt Lake City, Utah
- dUniversity of Colorado School of Medicine, Aurora, Colorado
- eDuke University Hospital, Durham, North Carolina
- fNorthside Cardiovascular Institute, Atlanta, Georgia
- gUniversity of Maryland School of Medicine, Baltimore, Maryland
- hColumbia University Medical Center, Center for Interventional Vascular Therapy, New York, New York
- iNorthwell Health, Manhasset, New York
- jHofstra North Shore—LIJ School of Medicine, Manhasset, New York
- kUCLA-Olive View, Los Angeles, California
- lUniversity of Colorado Medical School, Denver, Colorado
- mThe Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio
- ↵∗ADDRESS FOR CORRESPONDENCE:
Dr. Ehtisham Mahmud, Professor and Division Chief, Cardiovascular Medicine, University of California-San Diego, 9434 Medical Center Drive, La Jolla, California 92037.
The worldwide pandemic caused by the novel acute respiratory syndrome coronavirus 2 has resulted in a new and lethal disease termed coronavirus disease-2019 (COVID-19). Although there is an association between cardiovascular disease and COVID-19, the majority of patients who need cardiovascular care for the management of ischemic heart disease may not be infected with this novel coronavirus. The objective of this document is to provide recommendations for a systematic approach for the care of patients with an acute myocardial infarction (AMI) during the COVID-19 pandemic. There is a recognition of two major challenges in providing recommendations for AMI care in the COVID-19 era. Cardiovascular manifestations of COVID-19 are complex with patients presenting with AMI, myocarditis simulating an ST-elevation myocardial infarction (STEMI) presentation, stress cardiomyopathy, non-ischemic cardiomyopathy, coronary spasm, or nonspecific myocardial injury, and the prevalence of COVID-19 disease in the U.S. population remains unknown with risk of asymptomatic spread. This document addresses the care of these patients focusing on 1) the varied clinical presentations; 2) appropriate personal protection equipment (PPE) for health care workers; 3) role of the Emergency Department, Emergency Medical System and the Cardiac Catheterization Laboratory; and 4) Regional STEMI systems of care. During the COVID-19 pandemic, primary PCI remains the standard of care for STEMI patients at PCI capable hospitals when it can be provided in a timely fashion, with an expert team outfitted with PPE in a dedicated CCL room. A fibrinolysis-based strategy may be entertained at non-PCI capable referral hospitals or in specific situations where primary PCI cannot be executed or is not deemed the best option.
- acute myocardial infarction
- emergency medical system
- percutaneous coronary intervention
This article has been co-published in Catheterization and Cardiovascular Interventions and the Journal of the American College of Cardiology.
Frederick G.P. Welt, Ajay J. Kirtane, John S. Rumsfeld and Timothy D. Henry are representatives of the American College of Cardiology. Amal Mattu is a representative of the American College of Emergency Physicians. Ehtisham Mahmud, John C. Messenger, Sunil V. Rao, Cindy Grines, and Timothy D. Henry are representatives of the Society of Cardiovascular Angiography & Interventions. This document was endorsed by the American College of Cardiology (ACC), the American College of Emergency Physicians (ACEP), and the Society for Cardiovascular Angiography & Interventions (SCAI) in April 2020.
- 2020 American College of Cardiology Foundation and Wiley Periodicals, Inc