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Ceasovschih A, Mantzouranis E, Dimitriadis K, Sorodoc V, Vlachakis PK, Karanikola AE, Theofilis P, Koutsopoulos G, Drogkaris S, Andrikou I, Valatsou A, Lazaros G, Sorodoc L, Tsioufis K. Coronary artery thromboembolism as a cause of myocardial infarction with non-obstructive coronary arteries (MINOCA). Hellenic J Cardiol 2024; 79:70-83. [PMID: 38825235 DOI: 10.1016/j.hjc.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/09/2024] [Accepted: 05/03/2024] [Indexed: 06/04/2024] Open
Abstract
Acute myocardial infarction (AMI) usually represents the clinical manifestation of atherothrombotic coronary artery disease (CAD) resulting from atherosclerotic plaque rupture. However, there are cases in which coronary angiography or coronary computed tomography angiography reveals patients with acute coronary syndrome with non-obstructive CAD. This clinical entity is defined as myocardial infarction with non-obstructive coronary arteries (MINOCA) and often considered as a clinical dynamic working diagnosis that needs further investigations for the establishment of a final etiologic diagnosis. The main causes of a MINOCA working diagnosis include atherosclerotic, non-atherosclerotic (vessel-related and non-vessel-related), and thromboembolic causes This literature review aimed to investigate the major thromboembolic causes in patients presenting with MINOCA regarding their etiology and pathophysiologic mechanisms, as well as diagnostic and treatment methods.
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Affiliation(s)
- Alexandr Ceasovschih
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, Iasi, Romania
| | - Emmanouil Mantzouranis
- First University Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyriakos Dimitriadis
- First University Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece.
| | - Victorita Sorodoc
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, Iasi, Romania
| | - Panayotis K Vlachakis
- First University Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Panagiotis Theofilis
- First University Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - George Koutsopoulos
- First University Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Drogkaris
- First University Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Andrikou
- First University Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Angeliki Valatsou
- First University Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - George Lazaros
- First University Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Laurentiu Sorodoc
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, Iasi, Romania
| | - Konstantinos Tsioufis
- First University Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
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Choi HK, Maity M, Qureshi M, Haider A, Kapadia S, Fuerte S, Antony S, Razzaq W, Akbar A. Multifaceted Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on ST-Elevation Myocardial Infarction (STEMI): A Literature Review of Incidence, Treatment Modalities, and Outcomes. Cureus 2024; 16:e57288. [PMID: 38690470 PMCID: PMC11059148 DOI: 10.7759/cureus.57288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 05/02/2024] Open
Abstract
The global repercussions of coronavirus disease 2019 (COVID-19) include substantial worldwide mortality and have brought to light existing gaps in healthcare systems. Particularly, diseases requiring time-sensitive treatment, such as ST-elevation myocardial infarction (STEMI), have faced significant challenges due to the impact and revelations of the COVID-19 pandemic on healthcare infrastructure. This review addresses the impact of the pandemic on STEMI, exploring incidence, treatment modalities, and clinical outcomes. Through a critical examination of existing literature, the intricate relationship between the pandemic and cardiovascular health, specifically STEMI, is elucidated. The COVID-19 pandemic has had a significant impact on the management of STEMI, with changes in hospitalization rates, treatment strategies, and the presentation of the disease posing significant challenges. The contradictory results of COVID-19 and post-vaccine myocardial infarction, as well as gender differences in reported cases, highlight the need for further research to clarify these relationships.
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Affiliation(s)
- Hoi K Choi
- Internal Medicine, University of Michigan, Ann Arbor, USA
| | - Madhurima Maity
- Internal Medicine, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, IND
| | - Mohammed Qureshi
- Internal Medicine, American University of the Caribbean School of Medicine, Cupecoy, SXM
| | - Ali Haider
- Medicine, Quetta Institute of Medical Sciences, Quetta, PAK
| | | | - Sofia Fuerte
- Internal Medicine, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, MEX
| | - Simon Antony
- Internal Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | | | - Anum Akbar
- Pediatrics, University of Nebraska Medical Center, Omaha, USA
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3
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Shavelle DM, Bosson N, French WJ, Thomas JL, Niemann JT, Gausche-Hill M, Rollman JE, Rafique AM, Klomhaus AM, Kloner RA. Association of the COVID-19 Pandemic on Treatment Times for ST-Elevation Myocardial Infarction: Observations from the Los Angeles County Regional System. Am J Cardiol 2024; 213:93-98. [PMID: 38016494 DOI: 10.1016/j.amjcard.2023.11.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/03/2023] [Accepted: 11/11/2023] [Indexed: 11/30/2023]
Abstract
Previous studies have documented longer treatment times and worse outcomes for patients with ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) during the COVID-19 pandemic. The objective of the present study was to evaluate the impact of the COVID-19 pandemic on treatment times and outcomes for patients with STEMI who underwent primary PCI within a regional system of care. This was a retrospective study using data from the Los Angeles County Emergency Medical Services Agency. Data on the emergency medical service activations were abstracted for patients with STEMI from March 19, 2020 to January 31, 2021, during the COVID-19 pandemic and for the same interval the previous year. All adult patients (≥18 years) with STEMI who underwent emergent coronary angiography were included. The primary end point was the first medical contact (FMC) to device time. The secondary end points included treatment time intervals, vascular complications, need for emergent coronary artery bypass surgery, length of hospital stay, and in-hospital mortality. During the study period, 3,017 patients underwent coronary angiography for STEMI, 1,893 patients pre-COVID-19 and 1,124 patients during COVID-19 (40% lower). A total of 2,334 patients (77%) underwent PCI. During the COVID-19 period, rates of PCI were significantly lower compared with the control period (75.1% vs 78.7%, p = 0.02). FMC to device time was shorter during the COVID-19 period compared with the control period (median 77.0 vs 81.0 minutes, p = 0.004). For patients with STEMI complicated by out-of-hospital cardiac arrest, FMC to device time was similar during the COVID-19 period compared with the control period (median 95.0 [33.0] vs 100.0 [40.0] minutes, p = 0.34). Vascular complications, the need for emergent bypass surgery, length of hospital stay, and in-hospital mortality were similar between the periods. In conclusion, in this large regional system of care, we found a relatively small but significant decrease in treatment times, yet overall, similar clinical outcomes for patients with STEMI who underwent primary PCI and were treated during the COVID-19 period compared with a control period. These findings suggest that mature cardiac systems of care were able to maintain efficient care despite the challenges of the COVID-19 pandemic.
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Affiliation(s)
- David M Shavelle
- Memorial Care Heart and Vascular Institute, Long Beach Medical Center, Long Beach, California.
| | - Nichole Bosson
- Los Angeles County EMS Agency, Sante Fe Springs, California; David Geffen School of Medicine, University of California, Los Angeles, California; Department of Emergency Medicine, Harbor UCLA Medical Center, Torrance, California
| | - William J French
- David Geffen School of Medicine, University of California, Los Angeles, California; Division of Cardiology, Harbor UCLA Medical Center, Torrance, CA
| | - Joseph L Thomas
- David Geffen School of Medicine, University of California, Los Angeles, California; Division of Cardiology, Harbor UCLA Medical Center, Torrance, CA
| | - James T Niemann
- David Geffen School of Medicine, University of California, Los Angeles, California; Department of Emergency Medicine, Harbor UCLA Medical Center, Torrance, California
| | - Marianne Gausche-Hill
- Los Angeles County EMS Agency, Sante Fe Springs, California; David Geffen School of Medicine, University of California, Los Angeles, California; Department of Emergency Medicine, Harbor UCLA Medical Center, Torrance, California
| | - Jeffrey Eric Rollman
- Department of Health Policy and Management, UCLA Fielding School of Public Health
| | - Asim M Rafique
- David Geffen School of Medicine, University of California, Los Angeles, California; Division of Cardiology, Department of Medicine, and
| | - Alexandra M Klomhaus
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Robert A Kloner
- Keck School of Medicine, University of Southern California, Los Angeles, California; Huntington Medical Research Institutes, Pasadena, California
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Pourasghari H, Kolivand P, Azari S, Saberian P, Behzadifar M, Omidi N, Salehbeigi S, Raei B, Rajaie S, Luigi Bragazzi N, Golpira R, Khorgami MR, Khani M, Montazerinamin S, Lotfi F, Tajdini M. Epidemiological, clinical, and economic burden of myocardial infarction patients in Iran during the COVID-19 pandemic. IJC HEART & VASCULATURE 2023; 49:101288. [PMID: 38020058 PMCID: PMC10652134 DOI: 10.1016/j.ijcha.2023.101288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023]
Abstract
Background To define changes in AMI case rates, patient demographics, cardiovascular comorbidities, treatment approaches, in-hospital outcomes, and the economic burden of COVID-19 during the pandemic. Methods We conducted a multicenter, observational survey with selected hospitals from three medical universities in Tehran city. A data collection tool consisting of three parts. The first part included socio-demographic information, and the second part included clinical information, major complications, and in-hospital mortality. Finally, the third part was related to the direct medical costs generated by AMI in COVID-19 and non-COVID-19 patients. The study cohort comprised 4,560 hospitalizations for AMI (2,935 for STEMI [64%] and 1,625 for NSTEMI [36%]). Results Of those hospitalized for AMI, 1,864 (76.6 %) and 1,659 (78 %) were male before the COVID-19 outbreak and during the COVID-19 era, respectively. The length of stay (LOS), was significantly lower during the COVID-19 pandemic era (4.27 ± 3.63 vs 5.24 ± 5.17, p = 0.00). Results showed that there were no significant differences in terms of patient risk factors across periods. A total of 2,126 AMIs were registered during the COVID-19 era, with a 12.65 % reduction (95 % CI 1.5-25.1) compared with the equivalent time in 2019 (P = 0.179). The risk of in-hospital mortality rate for AMI patients increased from 4.9 % in 2019 to 7.0 % in the COVID-19 era (OR = 1.42; 95 % CI 1.11-1.82; P = 0.004). Major complications were registered in 9.7 % of cases in 2020, which is higher than the rate of 6.6 % reported in 2019 (OR = 1.46, 95 % CI 1.11-1.82; P = 0.000). Total costs in hospitalized AMI-COVID patients averaged $188 more than in AMI patients (P = 0.020). Conclusion This cross-sectional study found important changes in AMI hospitalization rates, worse outcomes, and higher costs during the COVID-19 periods. Future studies are recommended to examine the long-term outcomes of hospitalized AMI patients during the COVID-19 era.
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Affiliation(s)
- Hamid Pourasghari
- Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Pirhossein Kolivand
- Department of Health Economics, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Samad Azari
- Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Peyman Saberian
- Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Negar Omidi
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Salehbeigi
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Behzad Raei
- Razi Educational and Therapeutic Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Soheila Rajaie
- Research Center for Emergency and Disaster Resilience, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran
| | - Nicola Luigi Bragazzi
- Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Golpira
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammd Rafie Khorgami
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Khani
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Montazerinamin
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Lotfi
- National Center for Health Insurance Research, Tehran, Iran
| | - Masih Tajdini
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Lemke VG, Paiva MSS, Mariano GZ, Alves TS, Ferreira E, Nunes LA, Oliveira FRA, Cantarelli R, do Nascimento EM, de Oliveira GMM. Brazilian Registry of Interventional Cardiology during the COVID-19 Pandemic (RBCI-COVID19). Arq Bras Cardiol 2023; 120:e20220840. [PMID: 37672473 PMCID: PMC10519241 DOI: 10.36660/abc.20220840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 04/08/2023] [Accepted: 05/17/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND At the beginning of the COVID-19 pandemic, patients with myocardial infarction (MI) took longer to present to hospitals because of fear of contamination and health care access difficulties. OBJECTIVES To assess interventional cardiology procedures performed during the COVID-19 pandemic and its implications for MI approach. METHODS Prospective registry of 24 cardiac catheterization laboratories in Brazil, with adult patients undergoing interventional cardiology procedures between May 26 and November 30, 2020. The outcomes were cardiovascular (CV) and non-CV complications, death, and MI. Concomitant COVID-19 was confirmed using RT-PCR. Machine learning techniques were used with nonparametric Classification Trees models, and Simple Correspondence Analysis, with R statistical software package. Significance level adopted of 5%. RESULTS This study included 1282 patients, 435 of whom (33.9%) had MI as follows: ST-segment elevation MI (STEMI), 239 (54.9%); and non-ST-segment elevation MI (NSTEMI), 196 (45.1%). Of the 1282 patients, 29 had CV complications, 47 had non-CV complications, and 31 died. The diagnosis of COVID-19 was confirmed in 77 patients (6%), with 15.58% mortality and non-CV complications in 6.49%. Most patients had significant coronary artery disease (63%), and an intracoronary thrombus was more often found in the presence of STEMI (3.4%) and COVID-19 (4%). A door-to-table time longer than 12 hours in NSTEMI was associated with 30.8% of complications, 25% in COVID-19 patients. CONCLUSIONS All deaths were preceded by CV or non-CV complications. The presence of COVID-19 was associated with death and non-fatal complications of patients undergoing interventional cardiology procedures during the pandemic.
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Affiliation(s)
| | - Maria Sanali Souza Paiva
- Hospital Universitário Onofre LopesNatalRNBrasilHospital Universitário Onofre Lopes – HUOL, Natal, RN – Brasil
| | | | - Thales Siqueira Alves
- Hospital Universitário Pedro ErnestoRio de JaneiroRJBrasilHospital Universitário Pedro Ernesto, Rio de Janeiro, RJ – Brasil
| | - Esmeralci Ferreira
- Universidade do Estado do Rio de JaneiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro – Doenças do Tórax, Rio de Janeiro, RJ – Brasil
| | - Leonardo Avany Nunes
- Hospital São João BatistaCriciúmaSCBrasilHospital São João Batista, Criciúma, SC – Brasil
| | | | - Rodrigo Cantarelli
- Universidade do Estado do Rio de JaneiroRio de JaneitoRJBrasilUniversidade do Estado do Rio de Janeiro, Rio de Janeito, RJ – Brasil
| | - Emilia Matos do Nascimento
- Universidade do Estado do Rio de JaneiroRio de JaneitoRJBrasilUniversidade do Estado do Rio de Janeiro, Rio de Janeito, RJ – Brasil
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Grundeken MJ, Claessen BEPM. Impact of the COVID-19 Outbreak on the Treatment of Myocardial Infarction Patients. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2023; 25:1-11. [PMID: 37360185 PMCID: PMC10250853 DOI: 10.1007/s11936-023-00988-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/28/2023]
Abstract
Purpose of review The COVID-19 pandemic has led to an overburdened healthcare system. While an increased rate of ACS is expected due to the pro-thrombotic state of COVID patients, observed ACS incidence and admission rates were paradoxically decreased during the (first wave of the) pandemic. In this narrative review, we will discuss potential reasons for this decrease in ACS incidence. Furthermore, we will discuss ACS management during the COVID-19 pandemic, and we will discuss outcomes in ACS. Recent findings A reluctance to seek medical contact (in order not to further overburden the health system or due to fear of being infected with COVID-19 while in hospital) and unavailability of medical services seem to be important factors. This may have led to an increased symptom onset to first medical contact time and an increased rate of out-of-hospital cardiac arrests. A trend towards less invasive management was observed (less invasive coronary angiography in NSTEMI patients and more "fibrinolysis-first" in STEMI patients), although a large variation was observed with some centers having a relative increase in early invasive management. Patients with ACS and concomitant COVID-19 infection have worse outcomes compared to ACS patients without COVID-19 infection. All of the above led to worse clinical outcomes in patients presenting with ACS during the COVID-19 pandemic. Interestingly, staffing and hospital bed shortages led to experimentation with very early discharge (24 h after primary PCI) in low-risk STEMI patients which had a very good prognosis and resulted in significant shorter hospital duration. Summary During the COVID-19 pandemic, ACS incidence and admission rates were decreased, symptom onset to first medical contact time prolonged, and out-of-hospital rates increased. A trend towards less invasive management was observed. Patients presenting with ACS during the COVID-19 pandemic had a worse outcome. On the other hand, experimental very early discharge in low-risk patients may relieve the healthcare system. Such initiatives, and strategies to lower the reluctance of patients with ACS symptoms to seek medical help, are vital to improve prognosis in ACS patients in future pandemics.
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Affiliation(s)
- Maik J. Grundeken
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, Netherlands
| | - Bimmer E. P. M. Claessen
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, Netherlands
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El-Qushayri AE, Dahy A, Benmelouka AY, Kamel AMA. The effect of COVID-19 on the in-hospital outcomes of percutaneous coronary intervention in patients with acute coronary syndrome: A large scale meta-analysis. AMERICAN JOURNAL OF MEDICINE OPEN 2023; 9:100032. [PMID: 36685608 PMCID: PMC9847364 DOI: 10.1016/j.ajmo.2023.100032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/28/2022] [Accepted: 01/07/2023] [Indexed: 01/19/2023]
Abstract
Aim We aimed to study the effect of COVID-19 on the in-hospital outcomes of percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). Method A systematic literature search was performed in 2nd February 2022 updated in 12th December 2022 for recruiting relevant papers. The effect size was computed via the odds ratio (OR) for dichotomous data or standardized mean difference (SMD) for continuous data along with the 95% confidence interval (95%CI). Results After the screening of 1075 records, we found 11 relevant papers that included 2018 COVID-19 patients and negative controls 21,207. ACS patients with COVID-19 had a significant higher mortality rate (OR: 4.95; 95%CI: 3.92-6.36; p <0.01), long hospital stay (days) (SMD: 1.17; 95%CI: 0.92-1.42; p <0.01), and reduced post TIMI 3 score (OR: 0.55; 95%CI: 0.41-0.73; p <0.01) rather than controls. However, we found no significant differences in terms of thrombus aspiration prevalence (OR: 1.88; 95%CI: 0.97-3.65; p = 0.06) or door to balloon time (SMD: 0.11; 95%CI: -0.43-0.66; p = 0.7). Conclusion Despite that we found a significant association between COVID-19 and high mortality, more length of hospital stay and reduced post TIMI 3 score, in ACS patients after PCI, a rigorous analysis of the adjusted hazard ratio -that was absent in most of the included studies- by further meta-analysis is recommended to confirm this association. However, close monitoring of COVID-19 in patients with a high risk of developing ACS, is recommended due to the associated hypercoagulability of COVID-19 infection.
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Ghasemzadeh N, Kim N, Amlani S, Madan M, Shavadia JS, Chong AY, Bagherli A, Bagai A, Saw J, Singh J, Dehghani P. A Review of ST-Elevation Myocardial Infarction in Patients with COVID-19. Heart Fail Clin 2023; 19:197-204. [PMID: 36863811 PMCID: PMC9973551 DOI: 10.1016/j.hfc.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic has led to a significant increase in worldwide morbidity and mortality. Patients with COVID-19 are at risk for developing a variety of cardiovascular conditions including acute coronary syndromes, stress-induced cardiomyopathy, and myocarditis. Patients with COVID-19 who develop ST-elevation myocardial infarction (STEMI) are at a higher risk of morbidity and mortality when compared with their age- and sex-matched STEMI patients without COVID-19. We review current knowledge on the pathophysiology of STEMI in patients with COVID-19, clinical presentation, outcomes, and the effect of the COVID-19 pandemic on overall STEMI care.
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Affiliation(s)
| | - Nathan Kim
- Northeast Georgia Health System, Gainesville, GA 30501, USA
| | - Shy Amlani
- William Osler Health System, Brampton, 2100 Bovaird Drive East, Ontario L6R 3J7, Canada
| | - Mina Madan
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Jay S Shavadia
- Royal University Hospital, Saskatchewan Health, University of Saskatchewan Saskatoon, 103 Hospital Drive, Saskatchewan S7N 0W8, Canada
| | - Aun-Yeong Chong
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | - Alireza Bagherli
- Windsor Regional Hospital, 1030 Ouellette Avenue, Windsor, Ontario N9A 1E1, Canada
| | - Akshay Bagai
- Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - Jacqueline Saw
- Vancouver General Hospital, Vancouver, 12th Avenue, Vancouver, British Columbia V5Z 1M9, Canada
| | - Jyotpal Singh
- Prairie Vascular Research Inc, Regina, 1440 14 Avenue, Saskatchewan S4P 0W5, Canada
| | - Payam Dehghani
- Prairie Vascular Research Inc, Regina, 1440 14 Avenue, Saskatchewan S4P 0W5, Canada.
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Laino ME, Ammirabile A, Motta F, De Santis M, Savevski V, Francone M, Chiti A, Mannelli L, Selmi C, Monti L. Advanced Imaging Supports the Mechanistic Role of Autoimmunity and Plaque Rupture in COVID-19 Heart Involvement. Clin Rev Allergy Immunol 2023; 64:75-89. [PMID: 35089505 PMCID: PMC8796606 DOI: 10.1007/s12016-022-08925-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 01/26/2023]
Abstract
The cardiovascular system is frequently affected by coronavirus disease-19 (COVID-19), particularly in hospitalized cases, and these manifestations are associated with a worse prognosis. Most commonly, heart involvement is represented by myocarditis, myocardial infarction, and pulmonary embolism, while arrhythmias, heart valve damage, and pericarditis are less frequent. While the clinical suspicion is necessary for a prompt disease recognition, imaging allows the early detection of cardiovascular complications in patients with COVID-19. The combination of cardiothoracic approaches has been proposed for advanced imaging techniques, i.e., CT scan and MRI, for a simultaneous evaluation of cardiovascular structures, pulmonary arteries, and lung parenchyma. Several mechanisms have been proposed to explain the cardiovascular injury, and among these, it is established that the host immune system is responsible for the aberrant response characterizing severe COVID-19 and inducing organ-specific injury. We illustrate novel evidence to support the hypothesis that molecular mimicry may be the immunological mechanism for myocarditis in COVID-19. The present article provides a comprehensive review of the available evidence of the immune mechanisms of the COVID-19 cardiovascular injury and the imaging tools to be used in the diagnostic workup. As some of these techniques cannot be implemented for general screening of all cases, we critically discuss the need to maximize the sustainability and the specificity of the proposed tests while illustrating the findings of some paradigmatic cases.
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Affiliation(s)
- Maria Elena Laino
- Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Angela Ammirabile
- Department of Radiology and Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Francesca Motta
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Maria De Santis
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Victor Savevski
- Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marco Francone
- Department of Radiology and Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Arturo Chiti
- Department of Radiology and Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - Lorenzo Monti
- Department of Radiology and Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Anghel L, Tudurachi BS, Leonte A, Sascău RA, Zota IM, Bazyani A, Tinică G, Stătescu C. The Challenge of High Coronary Thrombotic Events in Patients with ST-Segment Elevation Myocardial Infarction and COVID-19. J Clin Med 2022; 11:6542. [PMID: 36362770 PMCID: PMC9654578 DOI: 10.3390/jcm11216542] [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: 10/02/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
The aim of this observational study was to describe the characteristics and outcomes of coronavirus disease 2019 (COVID-19)-positive patients with ST-segment elevation myocardial infarction (STEMI), with a special focus on factors associated with a high risk of coronary thrombosis and in-hospital mortality. Comparing the two groups of patients with STEMI separated according to the presence of SARS-CoV-2 infections, it was observed that COVID-19 patients were more likely to present with dyspnea (82.43% vs. 61.41%, p = 0.048) and cardiogenic shock (10.52% vs. 5.40%, p = 0.012). A longer total ischemia time was observed in COVID-19 patients, and they were twice as likely to undergo coronary angiography more than 12 hours after the onset of symptoms (19.29% vs. 10.13%, p = 0.024). In 10 of 57 COVID-19-positive patients, a primary PCI was not necessary, and only thromboaspiration was performed (17.54% vs. 2.70%, p < 0.001). Platelet level was inversely correlated (r = −0.512, p = 0.025) with a higher risk of coronary thrombosis without an atherosclerotic lesion. Using a cut-off value of 740 ng/ml, D-dimers predicted a higher risk of coronary thrombosis, with a sensitivity of 80% and a specificity of 66% (ROC area under the curve: 0.826, 95% CI: 0.716−0.935, p = 0.001). These are novel findings that raise the question of whether more aggressive antithrombotic therapy is necessary for selected COVID-19 and STEMI patients.
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Affiliation(s)
- Larisa Anghel
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania
| | - Bogdan-Sorin Tudurachi
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania
| | - Andreea Leonte
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania
| | - Radu Andy Sascău
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania
| | - Ioana Mădălina Zota
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania
| | - Amin Bazyani
- Interventional Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania
| | - Grigore Tinică
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiovascular Surgery Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania
| | - Cristian Stătescu
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania
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11
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Terlecki M, Wojciechowska W, Klocek M, Olszanecka A, Bednarski A, Drożdż T, Pavlinec C, Lis P, Zając M, Rusinek J, Siudak Z, Bartuś S, Rajzer M. Impact of concomitant COVID-19 on the outcome of patients with acute myocardial infarction undergoing coronary artery angiography. Front Cardiovasc Med 2022; 9:917250. [PMID: 36211554 PMCID: PMC9536466 DOI: 10.3389/fcvm.2022.917250] [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] [Received: 04/10/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background The impact of COVID-19 on the outcome of patients with MI has not been studied widely. We aimed to evaluate the relationship between concomitant COVID-19 and the clinical course of patients admitted due to acute myocardial infarction (MI). Methods There was a comparison of retrospective data between patients with MI who were qualified for coronary angiography with concomitant COVID-19 and control group of patients treated for MI in the preceding year before the onset of the pandemic. In-hospital clinical data and the incidence of death from any cause on 30 days were obtained. Results Data of 39 MI patients with concomitant COVID-19 (COVID-19 MI) and 196 MI patients without COVID-19 in pre-pandemic era (non-COVID-19 MI) were assessed. Compared with non-COVID-19 MI, COVID-19 MI was in a more severe clinical state on admission (lower systolic blood pressure: 128.51 ± 19.76 vs. 141.11 ± 32.47 mmHg, p = 0.024), higher: respiratory rate [median (interquartile range), 16 (14–18) vs. 12 (12–14)/min, p < 0.001], GRACE score (178.50 ± 46.46 vs. 161.23 ± 49.74, p = 0.041), percentage of prolonged (>24 h) time since MI symptoms onset to coronary intervention (35.9 vs. 15.3%; p = 0.004), and cardiovascular drugs were prescribed less frequently (beta-blockers: 64.1 vs. 92.8%, p = 0.009), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers: 61.5 vs. 81.1%, p < 0.001, statins: 71.8 vs. 94.4%, p < 0.001). Concomitant COVID-19 was associated with seven-fold increased risk of 30-day mortality (HR 7.117; 95% CI: 2.79–18.14; p < 0.001). Conclusion Patients admitted due to MI with COVID-19 have an increased 30-day mortality. Efforts should be focused on infection prevention and implementation of optimal management to improve the outcomes in those patients.
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Affiliation(s)
- Michał Terlecki
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Wiktoria Wojciechowska
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Klocek
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Agnieszka Olszanecka
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Adam Bednarski
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Drożdż
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Christopher Pavlinec
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Lis
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Zając
- Student's Scientific Group in the First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Rusinek
- Student's Scientific Group in the First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Stanisław Bartuś
- Second Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- *Correspondence: Marek Rajzer
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12
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Akkaif MA, Bitar AN, Al-Kaif LAIK, Daud NAA, Sha’aban A, Noor DAM, Abd Aziz F, Cesaro A, SK Abdul Kader MA, Abdul Wahab MJ, Khaw CS, Ibrahim B. The Management of Myocardial Injury Related to SARS-CoV-2 Pneumonia. J Cardiovasc Dev Dis 2022; 9:307. [PMID: 36135452 PMCID: PMC9503627 DOI: 10.3390/jcdd9090307] [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: 08/11/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 02/07/2023] Open
Abstract
The global evolution of the SARS-CoV-2 virus is known to all. The diagnosis of SARS-CoV-2 pneumonia is expected to worsen, and mortality will be higher when combined with myocardial injury (MI). The combination of novel coronavirus infections in patients with MI can cause confusion in diagnosis and assessment, with each condition exacerbating the other, and increasing the complexity and difficulty of treatment. It would be a formidable challenge for clinical practice to deal with this situation. Therefore, this review aims to gather literature on the progress in managing MI related to SARS-CoV-2 pneumonia. This article reviews the definition, pathogenesis, clinical evaluation, management, and treatment plan for MI related to SARS-CoV-2 pneumonia based on the most recent literature, diagnosis, and treatment trial reports. Many studies have shown that early diagnosis and implementation of targeted treatment measures according to the different stages of disease can reduce the mortality rate among patients with MI related to SARS-CoV-2 pneumonia. The reviewed studies show that multiple strategies have been adopted for the management of MI related to COVID-19. Clinicians should closely monitor SARS-CoV-2 pneumonia patients with MI, as their condition can rapidly deteriorate and progress to heart failure, acute myocardial infarction, and/or cardiogenic shock. In addition, appropriate measures need to be implemented in the diagnosis and treatment to provide reasonable care to the patient.
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Affiliation(s)
- Mohammed Ahmed Akkaif
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor 11800, Malaysia
| | - Ahmad Naoras Bitar
- Department of Clinical Pharmacy, Michel Sayegh College of Pharmacy, Aqaba University of Technology, South of Aqaba, South Beach Road, Opposite Aqaba Development Corporation Stores, Aqaba 910122, Jordan
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Malaysian Allied Health Sciences Academy, Jalan SP 2, Bandar Saujana Putra, Jenjarom 42610, Malaysia
| | - Laith A. I. K. Al-Kaif
- Department of Medical Laboratory Techniques, Al Mustaqbal University College, Hillah 51001, Babylon, Iraq
| | | | - Abubakar Sha’aban
- School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4YS, UK
| | | | | | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | | | | | - Chee Sin Khaw
- Department of Cardiology, Penang General Hospital, George Town 10990, Malaysia
| | - Baharudin Ibrahim
- Faculty of Pharmacy, University of Malaya, Kuala Lumpur 50603, Malaysia
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13
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Baral N, Abusnina W, Balmuri S, Seri A, Kambalapalli S, Parajuli PR, Abdelazeem B, Bashyal KP, Ojha N, Timilsina B, Paul TK. COVID-19 Positive Status is Associated with Increased In-hospital Mortality in Patients with Acute Myocardial Infarction: A Systematic Review and Meta-analysis. J Community Hosp Intern Med Perspect 2022; 12:17-24. [PMID: 36348971 PMCID: PMC9586181 DOI: 10.55729/2000-9666.1103] [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: 04/08/2022] [Revised: 06/08/2022] [Accepted: 06/22/2022] [Indexed: 11/20/2022] Open
Abstract
Patients hospitalized for acute myocardial infarction (AMI) may have concomitant positive coronavirus disease 2019 (COVID-19). We aimed to compare the risk of in-hospital mortality in patients primarily hospitalized for AMI with or without concomitant COVID-19 positive status. Using the random-effects model, we conducted a systematic review and meta-analysis of published articles from December 1, 2019, to April 1, 2022. There were eight studies with 10,128 patients, including 612 patients with COVID and 9516 patients without COVID. A total of 261 patients (42.64%) with COVID-19 positive and 612 patients (6.43%) with negative COVID-19 status died in the hospital. Pooled data showed that patients with a primary diagnosis of AMI with COVID-19 infection had more than five times increased risk of in-hospital mortality compared to patients without COVID-19 (OR: 5.06, 95% CI: 3.61, 7.09; I2 = 35%, P < 0.001). However, pooled data from five studies with adjustment of baseline differences in patient demographics and characteristics, comorbidities, and in-hospital pharmacology revealed more than three times increased risk of in-hospital mortality compared to patients who had primary AMI without COVID-19 infection (aOR: 3.47, 95% CI: 2.21, 5.45; I2 = 0%, P < 0.001). In subgroup analysis, ST-elevation myocardial infarction (STEMI) had lower in-hospital mortality (OR 4.23, 95% CI: 3.31, 5.40; I2 = 0%, P < 0.001) compared to non-ST-segment elevation myocardial infarction (NSTEMI) (OR 9.97, 95% CI: 5.71, 17.41; I2 = 0%, P < 0.001) (p-value = 0.006). Our study shows that COVID-19 infection is associated with increased in-hospital mortality in patients with index hospitalization for AMI.
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Affiliation(s)
- Nischit Baral
- Department of Medicine, McLaren Flint/Michigan State University, Flint, MI,
USA
| | - Waiel Abusnina
- Department of Internal Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, NE,
USA
| | - Shravya Balmuri
- Department of Medicine, McLaren Flint/Michigan State University, Flint, MI,
USA
| | - Amith Seri
- Department of Medicine, McLaren Flint/Michigan State University, Flint, MI,
USA
| | - Soumya Kambalapalli
- Department of Medicine, McLaren Flint/Michigan State University, Flint, MI,
USA
| | - Prem R. Parajuli
- Department of Internal Medicine, Tower Health-Reading Hospital, Reading, PA,
USA
| | - Basel Abdelazeem
- Department of Medicine, McLaren Flint/Michigan State University, Flint, MI,
USA
| | - Krishna P. Bashyal
- Department of Medicine, McLaren Flint/Michigan State University, Flint, MI,
USA
| | - Niranjan Ojha
- Department of Internal Medicine, Division of Cardiology, SUNY Upstate Medical University, Syracuse, NY,
USA
| | - Bidhya Timilsina
- Department of Internal Medicine, Division of Cardiology, Howard University, Washington, DC,
USA
| | - Timir K. Paul
- Department of Cardiovascular Sciences, University of Tennessee College of Medicine, Nashville, TN,
USA
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14
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Butt A, Erkan D, Lee AI. COVID-19 and antiphospholipid antibodies. Best Pract Res Clin Haematol 2022; 35:101402. [PMID: 36494152 PMCID: PMC9568270 DOI: 10.1016/j.beha.2022.101402] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 12/14/2022]
Abstract
Antiphospholipid syndrome and the coagulopathy of COVID-19 share many pathophysiologic features, including endotheliopathy, hypercoagulability, and activation of platelets, complement pathways, and neutrophil extracellular traps, all acting in concert via a model of immunothrombosis. Antiphospholipid antibody production in COVID-19 is common, with 50% of COVID-19 patients being positive for lupus anticoagulant in some studies, and with non-Sapporo criteria antiphospholipid antibodies being prevalent as well. The biological significance of antiphospholipid antibodies in COVID-19 is uncertain, as such antibodies are usually transient, and studies examining clinical outcomes in COVID-19 patients with and without antiphospholipid antibodies have yielded conflicting results. In this review, we explore the biology of antiphospholipid antibodies in COVID-19 and other infections and discuss mechanisms of thrombogenesis in antiphospholipid syndrome and parallels with COVID-19 coagulopathy. In addition, we review the existing literature on safety of COVID-19 vaccination in patients with antiphospholipid antibodies and antiphospholipid syndrome.
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Affiliation(s)
- Ayesha Butt
- Section of Hematology, Department of Medicine, Yale School of Medicine, 333 Cedar St., New Haven, CT, 06520, USA.
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery and Weill Cornell Medicine, 535 E. 70th St., 6th floor, New York, NY, 10021, USA.
| | - Alfred Ian Lee
- Section of Hematology, Department of Medicine, Yale School of Medicine, 333 Cedar St., New Haven, CT, 06520, USA.
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15
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Samuel AR. Acute Myocardial Infarction From Embolized Left Ventricular Thrombus in Coronavirus Disease 2019. J Nurse Pract 2022; 18:904-909. [PMID: 35721583 PMCID: PMC9197580 DOI: 10.1016/j.nurpra.2022.05.008] [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] [Indexed: 11/26/2022]
Abstract
A 44-year-old man with a late presentation of coronavirus disease 2019 (COVID-19) pneumonia developed a left ventricular apical thrombus resulting in an asymptomatic anterior myocardial infarction due to extensive thrombosis of the left anterior descending artery. There are increasing reports of thrombotic complications in patients infected with COVID-19. This case highlights the risk of thrombotic events caused by severe acute respiratory syndrome-related corona virus-2 and the associated challenges in management. The objective of this case report is to generate primary literature and raise awareness and appreciation for cardiac manifestations of COVID-19.
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16
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Cancro FP, Bellino M, Esposito L, Romei S, Centore M, D'Elia D, Cristiano M, Maglio A, Carrizzo A, Rasile B, Alfano C, Vecchione C, Galasso G. Acute Coronary Syndrome in Patients with SARS-CoV-2 Infection: Pathophysiology and Translational Perspectives. Transl Med UniSa 2022; 24:1-11. [PMID: 36447945 PMCID: PMC9673986 DOI: 10.37825/2239-9754.1034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 01/12/2023] Open
Abstract
Acute coronary syndromes (ACS) may complicate the clinical course of patients with Coronavirus Disease 2019 (COVID-19). It is still unclear whether this condition is a direct consequence of the primary disease. However, several mechanisms including direct cellular damage, endothelial dysfunction, in-situ thrombosis, systemic inflammatory response, and oxygen supply-demand imbalance have been described in patients with COVID-19. The onset of a prothrombotic state may also be facilitated by the endothelial dysfunction secondary to the systemic inflammatory response and to the direct viral cell damage. Moreover, dysfunctional endothelial cells may enhance vasospasm and platelet aggregation. The combination of these factors promotes atherosclerotic plaque instability, thrombosis and, consequently, type 1 myocardial infarction. Furthermore, severe hypoxia due to extensive pulmonary involvement, in association with other conditions described in COVID-19 such as sepsis, tachyarrhythmias, anemia, hypotension, and shock, may lead to mismatch between oxygen supply and demand, and cause type 2 myocardial infarction. A deeper understanding of the potential pathophysiological mechanisms underlying ACS in patients with COVID-19 could help the therapeutic management of these very high-risk patients.
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Affiliation(s)
- Francesco P. Cancro
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy,Corresponding author at: Department of Medicine, Surgery and Dentistry, University of Salerno, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Largo Città di Ippocrate, 84131 Salerno, Italy. Fax: +39 089 089 672805. E-mail address: (M. Bellino)
| | - Luca Esposito
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Stefano Romei
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Mario Centore
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Debora D'Elia
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Mario Cristiano
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Angelantonio Maglio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Albino Carrizzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy,Vascular Pathophysiology Unit, IRCCS Neuromed, Pozzilli, Isernia,
Italy
| | - Barbara Rasile
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Carmine Alfano
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy,Vascular Pathophysiology Unit, IRCCS Neuromed, Pozzilli, Isernia,
Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
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17
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Changes in the Incidence of Cardiovascular Diseases during the COVID-19 Pandemic in Korea. J Pers Med 2022; 12:jpm12071183. [PMID: 35887680 PMCID: PMC9319633 DOI: 10.3390/jpm12071183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/17/2022] Open
Abstract
There is scarcity in the evidence addressing the indirect impact of the COVID-19 pandemic on the epidemiology of CVDs. In this study we aimed to examine possible changes in the incidence of CVDs in Korea during the COVID-19 pandemic. ICD-10 codes of six common CVDs (cerebral hemorrhage, cerebral infarction, myocardial infarction, ischemic heart disease, cardiac failure, and arrhythmia) were collected from clinical visits between January 2018 and March 2021 using the National Health Insurance service database, which stores data on all citizens of Korea (~50 million people). The number and distribution of monthly visits for CVDs were compared before and during the COVID-19 pandemic, and the differences were analyzed using the Mann–Whitney U test and Levene’s test. Our data showed similar incidences of cerebral hemorrhage and ischemic heart disease, a lower incidence of cerebral infarction, and higher incidences of myocardial infarction, cardiac failure, and arrhythmia during COVID-19. Despite statistical differences, the changes in incidences were not considered meaningful. The monthly incidences also remained similar throughout the year, without seasonal variations, both before and during the COVID-19 outbreak. This study found no significant changes in the incidences or monthly variation in CVDs due to the COVID-19 pandemic in Korea.
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18
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Duca ȘT, Chetran A, Miftode RȘ, Mitu O, Costache AD, Nicolae A, Iliescu-Halițchi D, Halițchi-Iliescu CO, Mitu F, Costache II. Myocardial Ischemia in Patients with COVID-19 Infection: Between Pathophysiological Mechanisms and Electrocardiographic Findings. Life (Basel) 2022; 12:life12071015. [PMID: 35888103 PMCID: PMC9318430 DOI: 10.3390/life12071015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 12/29/2022] Open
Abstract
Given the possible pathophysiological links between myocardial ischemia and SARS-CoV-2 infection, several studies have focused attention on acute coronary syndromes in order to improve patients’ morbidity and mortality. Understanding the pathophysiological aspects of myocardial ischemia in patients infected with SARS-CoV-2 can open a broad perspective on the proper management for each patient. The electrocardiogram (ECG) remains the easiest assessment of cardiac involvement in COVID-19 patients, due to its non-invasive profile, accessibility, low cost, and lack of radiation. The ECG changes provide insight into the patient’s prognosis, indicating either the worsening of an underlying cardiac illnesses or the acute direct injury by the virus. This indicates that the ECG is an important prognostic tool that can affect the outcome of COVID-19 patients, which important to correlate its aspects with the clinical characteristics and patient’s medical history. The ECG changes in myocardial ischemia include a broad spectrum in patients with COVID-19 with different cases reported of ST-segment elevation, ST-segment depression, and T wave inversion, which are associated with severe COVID-19 disease.
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Affiliation(s)
- Ștefania Teodora Duca
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700145 Iasi, Romania; (Ș.T.D.); (R.Ș.M.); (O.M.); (A.D.C.); (A.N.); (D.I.-H.); (F.M.); (I.I.C.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Adriana Chetran
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700145 Iasi, Romania; (Ș.T.D.); (R.Ș.M.); (O.M.); (A.D.C.); (A.N.); (D.I.-H.); (F.M.); (I.I.C.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
- Correspondence: ; Tel.: +40-741089910
| | - Radu Ștefan Miftode
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700145 Iasi, Romania; (Ș.T.D.); (R.Ș.M.); (O.M.); (A.D.C.); (A.N.); (D.I.-H.); (F.M.); (I.I.C.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Ovidiu Mitu
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700145 Iasi, Romania; (Ș.T.D.); (R.Ș.M.); (O.M.); (A.D.C.); (A.N.); (D.I.-H.); (F.M.); (I.I.C.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Alexandru Dan Costache
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700145 Iasi, Romania; (Ș.T.D.); (R.Ș.M.); (O.M.); (A.D.C.); (A.N.); (D.I.-H.); (F.M.); (I.I.C.)
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Ana Nicolae
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700145 Iasi, Romania; (Ș.T.D.); (R.Ș.M.); (O.M.); (A.D.C.); (A.N.); (D.I.-H.); (F.M.); (I.I.C.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Dan Iliescu-Halițchi
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700145 Iasi, Romania; (Ș.T.D.); (R.Ș.M.); (O.M.); (A.D.C.); (A.N.); (D.I.-H.); (F.M.); (I.I.C.)
- Department of Cardiology, Arcadia Hospital, 700620 Iasi, Romania
| | - Codruța-Olimpiada Halițchi-Iliescu
- Department of Mother and Child Medicine-Pediatrics, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
- Department of Pedriatics, Arcadia Hospital, 700620 Iasi, Romania
| | - Florin Mitu
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700145 Iasi, Romania; (Ș.T.D.); (R.Ș.M.); (O.M.); (A.D.C.); (A.N.); (D.I.-H.); (F.M.); (I.I.C.)
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Irina Iuliana Costache
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700145 Iasi, Romania; (Ș.T.D.); (R.Ș.M.); (O.M.); (A.D.C.); (A.N.); (D.I.-H.); (F.M.); (I.I.C.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
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19
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Liori S, Pappas C, Rallidis L. ST-elevation myocardial infarction in a 39-year-old patient with "normal" coronary arteries as a thrombotic complication of COVID-19. J Cardiol Cases 2022; 25:335-337. [PMID: 34980952 PMCID: PMC8716165 DOI: 10.1016/j.jccase.2021.12.006] [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: 07/30/2021] [Revised: 11/12/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022] Open
Abstract
We report the case of a 39-year-old male without traditional risk factors for coronary artery disease (CAD), i.e. smoking, hypercholesterolemia, hypertension, diabetes mellitus, familial history of premature CAD, admitted with anterior ST-segment elevation myocardial infarction and concurrent coronavirus disease-2019 infection. Coronary angiography showed high intracoronary thrombus burden and thrombotic occlusion of the proximal segment of left anterior descending artery, while optical coherence tomography revealed intact endothelium after thromboaspiration.
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Affiliation(s)
- Sotiria Liori
- Second Department of Cardiology, National & Kapodistrian University of Athens School of Medicine, Attikon University Hospital, Athens, Greece
| | - Christos Pappas
- Second Department of Cardiology, National & Kapodistrian University of Athens School of Medicine, Attikon University Hospital, Athens, Greece
| | - Loukianos Rallidis
- Second Department of Cardiology, National & Kapodistrian University of Athens School of Medicine, Attikon University Hospital, Athens, Greece
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20
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Cannata A, Watson SA, Daniel A, Giacca M, Shah AM, McDonagh TA, Scott PA, Bromage DI. Impact of the COVID-19 pandemic on in-hospital mortality in cardiovascular disease: a meta-analysis. Eur J Prev Cardiol 2022; 29:1266-1274. [PMID: 34297822 PMCID: PMC8344916 DOI: 10.1093/eurjpc/zwab119] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/25/2021] [Accepted: 06/23/2021] [Indexed: 02/07/2023]
Abstract
AIMS The COVID-19 pandemic has resulted in excess mortality due to both COVID-19 directly and other conditions, including cardiovascular (CV) disease. We aimed to explore the excess in-hospital mortality, unrelated to COVID-19 infection, across a range of CV diseases. METHODS AND RESULTS A systematic search was performed for studies investigating in-hospital mortality among patients admitted with CV disease without SARS-CoV-2 infection compared with a period outside the COVID-19 pandemic. Fifteen studies on 27 421 patients with CV disease were included in the analysis. The average in-hospital mortality rate was 10.4% (n = 974) in the COVID-19 group and 5.7% (n = 1026) in the comparator group. Compared with periods outside the COVID-19 pandemic, the pooled risk ratio (RR) demonstrated increased in-hospital mortality by 62% during COVID-19 [95% confidence interval (CI) 1.20-2.20, P = 0.002]. Studies with a decline in admission rate >50% during the COVID-19 pandemic observed the greatest increase in mortality compared with those with <50% reduction [RR 2.74 (95% CI 2.43-3.10) vs. 1.21 (95% CI 1.07-1.37), P < 0.001]. The observed increased mortality was consistent across different CV conditions (P = 0.74 for interaction). CONCLUSIONS In-hospital mortality among patients admitted with CV diseases was increased relative to periods outside the pandemic, independent of co-infection with COVID-19. This effect was larger in studies with the biggest decline in admission rates, suggesting a sicker cohort of patients in this period. However, studies were generally poorly conducted, and there is a need for further well-designed studies to establish the full extent of mortality not directly related to COVID-19 infection.
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Affiliation(s)
- Antonio Cannata
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, 125 Coldharbour Lane, London SE5 9NU, UK
- Department of Cardiology, King’s College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Samuel A Watson
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, 125 Coldharbour Lane, London SE5 9NU, UK
- Department of Cardiology, King’s College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Allen Daniel
- Department of Cardiology, King’s College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Mauro Giacca
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Ajay M Shah
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, 125 Coldharbour Lane, London SE5 9NU, UK
| | - Theresa A McDonagh
- Department of Cardiology, King’s College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Paul A Scott
- Department of Cardiology, King’s College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Daniel I Bromage
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, 125 Coldharbour Lane, London SE5 9NU, UK
- Department of Cardiology, King’s College Hospital NHS Foundation Trust, London, SE5 9RS, UK
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21
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John K, Lal A, Sharma N, ElMeligy A, Mishra AK. Presentation and outcome of myocardial infarction with non-obstructive coronary arteries in coronavirus disease 2019. World J Crit Care Med 2022; 11:129-138. [PMID: 36331992 PMCID: PMC9136718 DOI: 10.5492/wjccm.v11.i3.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/01/2022] [Accepted: 04/22/2022] [Indexed: 02/06/2023] Open
Abstract
Among the cardiac complications of coronavirus disease 2019 (COVID-19), one increasingly reported in the literature is myocardial infarction with non-obstructive coronaries (MINOCA). We reviewed all reported cases of MINOCA in COVID-19 patients to summarize its clinical features, evaluation, and treatment. We performed a literature search in Pubmed using the search terms 'COVID-19' and 'MINOCA' or 'non-obstructive coronaries'. Among the reported cases, the mean age was 61.5 years (SD ± 13.4), and 50% were men. Chest pain was the presenting symptom in five patients (62.5%), and hypertension was the most common comorbidity (62.5%). ST-elevation was seen in most patients (87.5%), and the overall mortality rate was 37.5%. MINOCA in COVID-19 is an entity with a broad differential diagnosis. Therefore, a uniform algorithm is needed in its evaluation to ensure timely diagnosis and management.
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Affiliation(s)
- Kevin John
- Department of Critical Care, Believers Church Medical College Hospital, Thiruvalla 689103, Kerala, India
| | - Amos Lal
- Division of Pulmonary & Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Nitish Sharma
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Amr ElMeligy
- Division of Interventional Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
| | - Ajay K Mishra
- Department of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
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22
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Cedrone F, Di Martino G, Di Giovanni P, Greco E, Trebbi E, Romano F, Staniscia T. Reduction in Hospital Admissions for Cardiovascular Diseases (CVDs) during the Coronavirus Disease 2019 (COVID-19) Pandemic: A Retrospective Study from a Southern Italian Region in the Year 2020. Healthcare (Basel) 2022; 10:871. [PMID: 35628008 PMCID: PMC9140652 DOI: 10.3390/healthcare10050871] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/01/2022] [Accepted: 05/06/2022] [Indexed: 12/13/2022] Open
Abstract
(1) Background: The COVID-19 pandemic has indirect consequences for healthcare for other diseases, known as collateral damage. This situation heavily affects healthcare systems, causing changes in patterns of hospital admission. During the peak of the coronavirus disease 2019 pandemic, numerous studies reported a reduction in admissions for acute coronary syndrome. The aim of this study was to evaluate the incidence of admissions for cardiovascular diseases in Abruzzo, a region of Southern Italy, in the year 2020 and compare it to the two previous years (2018−2019). (2) Methods: This retrospective study was conducted in Abruzzo, Italy. The monthly number of admissions in the year 2020 was compared to a control period made from the average number of events that occurred in the previous two years (2018−2019). (3) Results: A global reduction in hospital admissions for all the cardiovascular diseases (CVDs) considered was observed. In particular, compared to the control period, in 2020, the number of admissions for ST-segment elevation myocardial infarction (STEMI) was lower by 34 (hospitalization rate ratio, HRR, 0.93; p < 0.001), the number of non-ST-segment-elevation myocardial infarctions (N-STEMI) was lower by 154.5 (HRR 0.89; p < 0.001), the number for acute coronary syndrome (ACS) was 340 lower (HRR 0.90; p < 0.001) and the number for heart failure (HF) was 1424.5 lower than during the control period (HRR 0.73; p < 0.001). (4) Conclusions: The results of this study show the impact of COVID-19 on admissions for CVDs, suggesting the need for strategic measures to overcome the burden of hospitalizations in future years.
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Affiliation(s)
- Fabrizio Cedrone
- Local Health Authority of Pescara, Via Paolini, 65100 Pescara, Italy;
| | | | - Pamela Di Giovanni
- Department of Pharmacy, “G. d’Annunzio” University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy;
| | - Emilio Greco
- Faculty of Innovative Technologies for Digital Communication, Link Campus University, Via del Casale di San Pio V 44, 00165 Roma, Italy;
| | - Edoardo Trebbi
- Department of Infectious Diseases and Public Health, “La Sapienza” University of Rome, Piazza Aldo Moro 5, 00138 Rome, Italy; (E.T.); (F.R.)
| | - Ferdinando Romano
- Department of Infectious Diseases and Public Health, “La Sapienza” University of Rome, Piazza Aldo Moro 5, 00138 Rome, Italy; (E.T.); (F.R.)
| | - Tommaso Staniscia
- Department of Medicine and Ageing Sciences, “G. d’Annunzio” University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy;
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23
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John K, Lal A, Sharma N, ElMeligy A, Mishra AK. Presentation and outcome of myocardial infarction with non-obstructive coronary arteries in coronavirus disease 2019. World J Crit Care Med 2022. [DOI: 10.5492/wjccm.v11.i3.128] [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: 02/06/2023] Open
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24
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Jaiswal V, Almas T, Peng Ang S, David Song, Shama N, Storozhenko T, Lnu K, Parmar G, Qaiser S, Naz S, Jaiswal A, Malik J. Symptomatology, prognosis and clinical findings of STEMI as a ramification of COVID-19: A systematic review and proportion meta-analysis. Ann Med Surg (Lond) 2022; 76:103429. [PMID: 35284069 PMCID: PMC8902059 DOI: 10.1016/j.amsu.2022.103429] [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: 12/27/2021] [Revised: 02/22/2022] [Accepted: 02/28/2022] [Indexed: 12/19/2022] Open
Abstract
Background There is an increasing COVID-19 population with concurrent STEMI. SARS-CoV-2 poses a significant risk of hypercoagulable and/or prothrombotic events due to the disturbance in hemostasis by affecting all three components of the Virchow's triad. These abnormalities in hemostasis are an increased risk factor for cardiovascular events, including acute thrombotic occlusion of coronary arteries leading to myocardial infarction. Objective The objective of this study is to collate the prognosis, symptomatology and clinical findings of COVID-19 adverse events causing STEMI. Methods Databases were queried with various keyword combinations to find applicable articles. Cardiovascular risk factors, symptomatology, mortality and rates of PCI were analyzed using random-effect model. Results 15 studies with a total of 379 patients were included in the final analysis. Mean age of patients was 62.82 ± 36.01, with a male predominance (72%, n = 274). Hypertension, dyslipidemia and diabetes mellitus were the most common cardiovascular risk factors among these patients, with a pooled proportion of 72%, 59% and 40% respectively. Dyspnea (61%, n = 131) was the most frequent presenting symptom, followed by chest pain (60%, n = 101) and fever (56%, n = 104). 62% of the patients had obstructive CAD during coronary angiography. The primary reperfusion method used in the majority of cases was percutaneous coronary intervention (64%, n = 124). Mortality, which is the primary outcome in our study, was relatively high, with a rate of 34% across studies. Conclusion Our findings show that most cases have been found in males, while the most common risk factors were Hypertension and Diabetes Mellitus. In most COVID-19 cases with ST-segment myocardial infarction, most hospitalized patients underwent primary percutaneous coronary intervention instead of fibrinolysis. The in-hospital mortality was significantly higher, making this report significant. As the sample size and reported study are considerably less, it warrants a further large-scale investigation to generalize it.
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Affiliation(s)
| | - Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - David Song
- Icahn School of Medicine at Mount Sinai, NY, USA
| | - Nishat Shama
- Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Tatyana Storozhenko
- Government Institution “L.T. Malaya Therapy National Institute NAMSU,” Kharkiv, Ukraine
| | - Kriti Lnu
- Department of Internal Medicine, UPMC Harrisburg, USA
| | | | | | - Sidra Naz
- Harvard Medical School, Boston, MA, USA
| | - Akash Jaiswal
- Department of Geriatric Medicine, All India Institute of Medical Science, New Delhi, India
| | - Jahanzeb Malik
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
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25
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Wang Y, Kang L, Chien CW, Xu J, You P, Xing S, Tung TH. Comparison of the Characteristics, Management, and Outcomes of STEMI Patients Presenting With vs. Those of Patients Presenting Without COVID-19 Infection: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:831143. [PMID: 35360030 PMCID: PMC8964144 DOI: 10.3389/fcvm.2022.831143] [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: 12/09/2021] [Accepted: 02/07/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the differences in the characteristics, management, and clinical outcomes of patients with and that of those without coronavirus disease 2019 (COVID-19) infection who had ST-segment elevation myocardial infarction (STEMI). METHODS Databases including Web of Science, PubMed, Cochrane Library, and Embase were searched up to July 2021. Observational studies that reported on the characteristics, management, or clinical outcomes and those published as full-text articles were included. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of all included studies. RESULTS A total of 27,742 patients from 13 studies were included in this meta-analysis. Significant delay in symptom onset to first medical contact (SO-to-FMC) time (mean difference = 23.42 min; 95% CI: 5.85-40.99 min; p = 0.009) and door-to-balloon (D2B) time (mean difference = 12.27 min; 95% CI: 5.77-18.78 min; p = 0.0002) was observed in COVID-19 patients. Compared to COVID-19 negative patients, those who are positive patients had significantly higher levels of C-reactive protein, D-dimer, and thrombus grade (p < 0.05) and showed more frequent use of thrombus aspiration and glycoprotein IIbIIIa (Gp2b3a) inhibitor (p < 0.05). COVID-19 positive patients also had higher rates of in-hospital mortality (OR = 5.98, 95% CI: 4.78-7.48, p < 0.0001), cardiogenic shock (OR = 2.75, 95% CI: 2.02-3.76, p < 0.0001), and stent thrombosis (OR = 5.65, 95% CI: 2.41-13.23, p < 0.0001). They were also more likely to be admitted to the intensive care unit (ICU) (OR = 4.26, 95% CI: 2.51-7.22, p < 0.0001) and had a longer length of stay (mean difference = 4.63 days; 95% CI: 2.56-6.69 days; p < 0.0001). CONCLUSIONS This study revealed that COVID-19 infection had an impact on the time of initial medical intervention for patients with STEMI after symptom onset and showed that COVID-19 patients with STEMI were more likely to have thrombosis and had poorer outcomes.
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Affiliation(s)
- Yanjiao Wang
- Shenzhen Bao'an District Traditional Chinese Medicine Hospital, Shenzhen, China
- Institute for Hospital Management, Tsing Hua University, Shenzhen, China
| | - Linlin Kang
- Shenzhen Bao'an District Traditional Chinese Medicine Hospital, Shenzhen, China
- Institute for Hospital Management, Tsing Hua University, Shenzhen, China
| | - Ching-Wen Chien
- Institute for Hospital Management, Tsing Hua University, Shenzhen, China
| | - Jiawen Xu
- Institute for Hospital Management, Tsing Hua University, Shenzhen, China
| | - Peng You
- Institute for Hospital Management, Tsing Hua University, Shenzhen, China
| | - Sizhong Xing
- Shenzhen Bao'an District Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
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26
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de Lange M, Carvalho AS, Brito Fernandes Ó, Lingsma H, Klazinga N, Kringos D. The Impact of the COVID-19 Pandemic on Hospital Services for Patients with Cardiac Diseases: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3172. [PMID: 35328859 PMCID: PMC8953098 DOI: 10.3390/ijerph19063172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/28/2022] [Accepted: 03/04/2022] [Indexed: 12/12/2022]
Abstract
This study aims to assess the impact of the COVID-19 pandemic on hospital cardiac care, as assessed by performance indicators. Scoping review methodology: performance indicators were extracted to inform on changes in care during January-June 2020. Database searches yielded 6277 articles, of which 838 met the inclusion criteria. After full-text screening, 94 articles were included and 1637 indicators were retrieved. Most of the indicators that provided information on changes in the number of admissions (n = 118, 88%) signaled a decrease in admissions; 88% (n = 15) of the indicators showed patients' delayed presentation and 40% (n = 54) showed patients in a worse clinical condition. A reduction in diagnostic and treatment procedures was signaled by 95% (n = 18) and 81% (n = 64) of the indicators, respectively. Length of stay decreased in 58% (n = 21) of the indicators, acute coronary syndromes treatment times increased in 61% (n = 65) of the indicators, and outpatient activity decreased in 94% (n = 17) of the indicators related to outpatient care. Telehealth utilization increased in 100% (n = 6). Outcomes worsened in 40% (n = 35) of the indicators, and mortality rates increased in 52% (n = 31). All phases of the pathway were affected. This information could support the planning of care during the ongoing pandemic and in future events.
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Affiliation(s)
- Mats de Lange
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.d.L.); (Ó.B.F.); (N.K.); (D.K.)
| | - Ana Sofia Carvalho
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.d.L.); (Ó.B.F.); (N.K.); (D.K.)
- Department of Public Health, Erasmus University Medical Center, Postbus, 3000 CA Rotterdam, The Netherlands;
| | - Óscar Brito Fernandes
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.d.L.); (Ó.B.F.); (N.K.); (D.K.)
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, H-1093 Budapest, Hungary
| | - Hester Lingsma
- Department of Public Health, Erasmus University Medical Center, Postbus, 3000 CA Rotterdam, The Netherlands;
| | - Niek Klazinga
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.d.L.); (Ó.B.F.); (N.K.); (D.K.)
| | - Dionne Kringos
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.d.L.); (Ó.B.F.); (N.K.); (D.K.)
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27
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Ghasemzadeh N, Kim N, Amlani S, Madan M, Shavadia JS, Chong AY, Bagherli A, Bagai A, Saw J, Singh J, Dehghani P. A Review of ST-elevation Myocardial Infarction in Patients with COVID-19. Cardiol Clin 2022; 40:321-328. [PMID: 35851455 PMCID: PMC8960128 DOI: 10.1016/j.ccl.2022.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Nathan Kim
- Northeast Georgia Health System, Gainesville, GA 30501, USA
| | - Shy Amlani
- William Osler Health System, Brampton, 2100 Bovaird Drive East, Ontario L6R 3J7, Canada
| | - Mina Madan
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Jay S Shavadia
- Royal University Hospital, Saskatchewan Health, University of Saskatchewan Saskatoon, 103 Hospital Drive, Saskatchewan S7N 0W8, Canada
| | - Aun-Yeong Chong
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | - Alireza Bagherli
- Windsor Regional Hospital, 1030 Ouellette Avenue, Windsor, Ontario N9A 1E1, Canada
| | - Akshay Bagai
- Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - Jacqueline Saw
- Vancouver General Hospital, Vancouver, 12th Avenue, Vancouver, British Columbia V5Z 1M9, Canada
| | - Jyotpal Singh
- Prairie Vascular Research Inc, Regina, 1440 14 Avenue, Saskatchewan S4P 0W5, Canada
| | - Payam Dehghani
- Prairie Vascular Research Inc, Regina, 1440 14 Avenue, Saskatchewan S4P 0W5, Canada.
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28
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The Impact of the Early COVID-19 Pandemic on ST-Segment Elevation Myocardial Infarction Presentation and Outcomes-A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12030588. [PMID: 35328141 PMCID: PMC8947375 DOI: 10.3390/diagnostics12030588] [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: 01/23/2022] [Revised: 02/13/2022] [Accepted: 02/23/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The influence of the early COVID-19 pandemic on non-COVID-19 emergencies is uncertain. We conducted a systematic review and a meta-analysis to evaluate the impact of the first months of the COVID-19 pandemic on the presentation, management, and prognosis of patients presenting with ST-segment elevation myocardial infarction (STEMI). Methods: We searched the PubMed, Scopus, and Embase databases from January to August 2020. A meta-analysis of studies comparing the profile, STEMI severity at presentation, reperfusion delay, and in-hospital mortality for patients presenting before and during the early COVID-19 pandemic was conducted. Fifteen cross-sectional observational studies including 20,528 STEMI patients from the pre-COVID period and 2190 patients diagnosed and treated during the first months of the COVID-19 pandemic met the inclusion criteria. Results: Patients presenting with STEMI during the pandemic were younger and had a higher comorbidity burden. The time interval between symptoms and first medical contact increased from 93.22 ± 137.37 min to 142 ± 281.60 min (p < 0.001). Door-to-balloon time did not differ significantly between the two periods (p = 0.293). The pooled odds ratio (OR) for low left ventricular ejection fraction at presentation during the pandemic was 2.24 (95% confidence interval (CI) 1.54−3.26) and for a presentation delay >24 h was 2.9 (95% CI 1.54−5.45) relative to before the pandemic. In-hospital mortality did not increase significantly during the outbreak (p = 0.97). Conclusion: During the first months of the COVID-19 pandemic, patients presenting with STEMI were addressed later in the course of the disease with more severe left ventricular impairment. In-hospital emergency circuits and care functioned properly with no increase in door-to-balloon time and early mortality.
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29
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Toscano O, Cosentino N, Campodonico J, Bartorelli AL, Marenzi G. Acute Myocardial Infarction During the COVID-19 Pandemic: An Update on Clinical Characteristics and Outcomes. Front Cardiovasc Med 2022; 8:648290. [PMID: 35004867 PMCID: PMC8733166 DOI: 10.3389/fcvm.2021.648290] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 11/26/2021] [Indexed: 12/12/2022] Open
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) has rapidly become a worldwide pandemic. On top of respiratory complications, COVID-19 is associated with major direct and indirect cardiovascular consequences, with the latter probably being even more relevant, especially in the setting of time-dependent cardiovascular emergencies. A growing amount of data suggests a dramatic decline in hospital admissions for acute myocardial infarction (AMI) worldwide during the COVID-19 pandemic, mostly since patients did not activate emergency medical systems because hospitals were perceived as dangerous places regarding the infection risk. Moreover, during the COVID-19 pandemic, patients with AMI had a significantly higher in-hospital mortality compared to those admitted before COVID-19, potentially due to late arrival to the hospital. Finally, no consensus has been reached regarding the most adequate healthcare management pathway for AMI and shared guidance on how to handle patients with AMI during the pandemic is still needed. In this review, we will provide an update on epidemiology, clinical characteristics, and outcomes of patients with AMI during the COVID-19 pandemic, with a special focus on its collateral cardiac impact.
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Affiliation(s)
- Olga Toscano
- Centro Cardiologico Monzino, I.R.C.C.S., Milan, Italy
| | - Nicola Cosentino
- Centro Cardiologico Monzino, I.R.C.C.S., Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, I.R.C.C.S., Milan, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy
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Sutherland N, Dayawansa NH, Filipopoulos B, Vasanthakumar S, Narayan O, Ponnuthurai FA, van Gaal W. Acute Coronary Syndrome in the COVID-19 Pandemic: Reduced Cases and Increased Ischaemic Time. Heart Lung Circ 2022; 31:69-76. [PMID: 34452843 PMCID: PMC8384488 DOI: 10.1016/j.hlc.2021.07.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 07/15/2021] [Accepted: 07/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The COVID-19 pandemic has led to unprecedented stress on health care systems, and has affected acute coronary syndrome treatment at every step. This study aimed to examine the impact of COVID-19 on patient presentations with acute coronary syndromes during the first and second pandemic wave in Melbourne, Victoria. METHOD A retrospective cohort study of adults presenting with cute coronary syndrome during the first pandemic wave from 1 March 2020 to 31 April 2020 and the second pandemic wave from 1 July 2020 to 31 August 2020 was compared to a control period from 1 March to 31 April 2019 at a single sub-tertiary referral centre in Melbourne, Victoria servicing a catchment area with a relatively high incidence of COVID-19 cases. RESULTS Three-hundred-and-thirty-five (335) patients were hospitalised with acute coronary syndromes across all three time periods. The total number of patients presenting with an acute coronary syndrome was reduced during the pandemic, with a higher proportion of ST elevation myocardial infarctions. Ischaemic times increased with time from symptom onset to first medical contact rising from 191 minutes in the control period to 292 minutes in the first wave (p=0.06) and 271 minutes in the second wave (p=0.06). Coronary angiography with subsequent revascularisation significantly increased from 55% in the control period undergoing revascularisation to 69% in the first wave (p<0.001) and 74% in the second wave (p<0.001). CONCLUSION A concerning reduction in acute coronary presentations occurred during the COVID-19 pandemic, associated with longer ischaemic times and a higher proportion requiring revascularisation. It is crucial that public awareness campaigns are instituted to address the contributing patient factors in future waves.
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Affiliation(s)
- Nigel Sutherland
- Department of Cardiology, Northern Health, Melbourne, Vic, Australia.
| | - Nalin H Dayawansa
- Department of Cardiology, Northern Health, Melbourne, Vic, Australia
| | | | | | - Om Narayan
- Department of Cardiology, Northern Health, Melbourne, Vic, Australia
| | | | - William van Gaal
- Department of Cardiology, Northern Health, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Melbourne, Vic, Australia
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Tanaka K, Matsumoto S, Nakazawa Y, Yamada T, Sonoda K, Nagano S, Hatano T, Yamasaki R, Nakahara I, Isobe N. Delays in Presentation Time Under the COVID-19 Epidemic in Patients With Transient Ischemic Attack and Mild Stroke: A Retrospective Study of Three Hospitals in a Japanese Prefecture. Front Neurol 2021; 12:748316. [PMID: 34777220 PMCID: PMC8578818 DOI: 10.3389/fneur.2021.748316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/30/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Coronavirus Disease 2019 (COVID-19) has spread worldwide with collateral damage and therefore might affect the behavior of stroke patients with mild symptoms seeking medical attention. Methods: Patients with ischemic stroke who were admitted to hospitals within 7 days of onset were retrospectively registered. The clinical characteristics, including onset-to-door time (ODT), of patients with a transient ischemic attack (TIA)/mild stroke (National Institutes of Health Stroke Scale [NIHSS] score of ≤ 3 on admission) or moderate/severe stroke were compared between those admitted from April 2019 to March 2020 (pre-COVID-19 period) and from April to September 2020 (COVID-19 period). Multivariable regression analysis was performed to identify factors associated with the ODT. Results: Of 1,100 patients (732 men, median age, 73 years), 754 were admitted during the pre-COVID-19 period, and 346 were admitted during the COVID-19 period. The number and proportion of patients with TIA/minor stroke were 464 (61.5%) in the pre-COVID-19 period and 216 (62.4%) during the COVID-19 period. Among patients with TIA/mild stroke, the ODT was longer in patients admitted during the COVID-19 period compared with that of the pre-COVID-19 period (median 864 min vs. 508 min, p = 0.003). Multivariable analysis revealed the COVID-19 period of admission was associated with longer ODT (standardized partial regression coefficient 0.09, p = 0.003) after adjustment for age, sex, route of arrival, NIHSS score on admission, and the presence of hypertension, diabetes mellitus, and wake-up stroke. No significant change in the ODT was seen in patients with moderate/severe stroke. Conclusions: The COVID-19 epidemic might increase the ODT of patients with TIA/mild stroke.
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Affiliation(s)
- Koji Tanaka
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shoji Matsumoto
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yusuke Nakazawa
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Takeshi Yamada
- Department of Neurology, Murakami Karindoh Hospital, Fukuoka, Japan
| | - Kazutaka Sonoda
- Department of Neurology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Sukehisa Nagano
- Department of Neurology, Fukuoka City Hospital, Fukuoka, Japan
| | - Taketo Hatano
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Ryo Yamasaki
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Noriko Isobe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Sofi F, Dinu M, Reboldi G, Stracci F, Pedretti RFE, Valente S, Gensini G, Gibson CM, Ambrosio G. Worldwide differences of hospitalization for ST-segment elevation myocardial infarction during COVID-19: A systematic review and meta-analysis. Int J Cardiol 2021; 347:89-96. [PMID: 34740717 PMCID: PMC8561779 DOI: 10.1016/j.ijcard.2021.10.156] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/04/2021] [Accepted: 10/29/2021] [Indexed: 12/30/2022]
Abstract
Background Discrepant data were reported about hospital admissions for ST-segment elevation myocardial infarction (STEMI) during COVID-19 pandemic. We reviewed studies reporting STEMI hospitalizations during COVID-19 pandemic, investigating whether differences in COVID-19 epidemiology or public health-related factors could explain discrepant findings in different countries. Methods Search through MedLine, Embase, Scopus, Web-of-Science, Cochrane Register of Controlled Trials, of studies comparing STEMI admissions during COVID-19 pandemic with a reference period, without language restrictions, as registered in PROSPERO International Prospective Register of Systematic Reviews. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed. Data independently extracted by multiple investigators were pooled using a random-effects model. Health-related metrics were from publicly-available sources. Results We included 79 articles (111,557 STEMI cases, from 57 countries). During peak COVID-19 pandemic, overall incidence rate-ratio (IRR) of STEMI hospitalizations over reference period decreased (0.80; 95% CI 0.76–0.84; p < 0.05). Although wide variations and significant heterogeneity were detected among studies (I2 = 89%; p < 0.0001), no significant differences were observed by report methodology (survey vs registry), or observation/reference period. However, large differences emerged at country level not explained by COVID-related epidemiological data, nor by public health strategies. Instead, IRRs for STEMI admissions were inversely related to hospital bed availability in each country (p < 0.05). Conclusions During COVID-19 pandemic hospitalization for STEMI significantly decreased, although to a smaller extent than initially reported. Large variability emerged across countries, unrelated to COVID-related epidemiology or social containment measures. Disparities in healthcare organization likely contributed, indicating that proper organization of emergency medicine should be preserved during pandemics.
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Affiliation(s)
- Francesco Sofi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Monica Dinu
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - GianPaolo Reboldi
- Department of Medicine, University of Perugia School of Medicine, Perugia, Italy; Center for Clinical and Translational Research-CERICLET, University of Perugia School of Medicine, Perugia, Italy
| | - Fabrizio Stracci
- Department of Medicine, University of Perugia School of Medicine, Perugia, Italy
| | | | | | | | - C Michael Gibson
- Baim Institute for Clinical Research, Harvard Medical School, Boston, MS, United States of America
| | - Giuseppe Ambrosio
- Center for Clinical and Translational Research-CERICLET, University of Perugia School of Medicine, Perugia, Italy; Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy.
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Zhu Y, Xing W, Wang H, Song J, Sun Z, Li X. Characteristics of patients with ST-segment elevated myocardial infarction (STEMI) at the initial stage of the COVID-19 pandemic: a systematic review and meta-analysis. Infect Dis (Lond) 2021; 53:865-875. [PMID: 34311652 DOI: 10.1080/23744235.2021.1953131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/02/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has become a new challenge to the medical system in various countries. The patients with ST-segment elevated myocardial infarction (STEMI) were also affected. METHODS We used a random-effects mode to analyze the differences of the baseline characteristics and therapeutic features between STEMI patients admitted before and after the start of the COVID-19 pandemic. RESULTS Thirty eight studies involving 79,753 patients were included in this analysis. The number of hospitalized STEMI patients decreased by 26% after the start of the COVID-19 pandemic. There were no differences in age, sex, prevalence of diabetes, hypertension, dyslipidemia or percutaneous coronary intervention rate between the STEMI patients before and after the start of the COVID-19 pandemic. However, the STEMI patients admitted after the start of the COVID-19 pandemic had a significantly increased time from symptom onset to first medical contact (standard mean difference: 0.51, 95% confidence interval: 0.24-0.78, p < .001) and an increased in-hospital mortality (odds ratio: 1.70, 95% confidence interval:1.14-2.56, p < .001); The in-hospital mortality of the STEMI patients with COVID-19 was 24% (95% confidence interval: 0.15-0.33); The in-hospital mortality of the STEMI patients with COVID-19 was significantly higher than that of the STEMI patients without COVID-19 at the initial stage of the COVID-19 pandemic (odds ratio: 7.28, 95% confidence interval: 2.75-19.28, p < .001). CONCLUSION The number of admitted STEMI patients was reduced while the in-hospital mortality and the time from symptom onset to first medical contact were increased during the COVID-19 pandemic.
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Affiliation(s)
- Yuhang Zhu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, P. R. China
| | - Wanying Xing
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, P. R. China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, P. R. China
| | - Jun Song
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, P. R. China
| | - Zhixia Sun
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, P. R. China
| | - Xingzhao Li
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, P. R. China
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Numasawa Y. Impact of Concomitant Novel Coronavirus Disease 2019 in Patients With ST-Elevation Acute Myocardial Infarction. Circ J 2021; 85:1708-1709. [PMID: 33854006 DOI: 10.1253/circj.cj-21-0184] [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: 11/09/2022]
Affiliation(s)
- Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital
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COVID-19 and Acute Coronary Syndromes: From Pathophysiology to Clinical Perspectives. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:4936571. [PMID: 34484561 PMCID: PMC8410438 DOI: 10.1155/2021/4936571] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/09/2021] [Indexed: 02/08/2023]
Abstract
Acute coronary syndromes (ACS) are frequently reported in patients with coronavirus disease 2019 (COVID-19) and may impact patient clinical course and mortality. Although the underlying pathogenesis remains unclear, several potential mechanisms have been hypothesized, including oxygen supply/demand imbalance, direct viral cellular damage, systemic inflammatory response with cytokine-mediated injury, microvascular thrombosis, and endothelial dysfunction. The severe hypoxic state, combined with other conditions frequently reported in COVID-19, namely sepsis, tachyarrhythmias, anemia, hypotension, and shock, can induce a myocardial damage due to the mismatch between oxygen supply and demand and results in type 2 myocardial infarction (MI). In addition, COVID-19 promotes atherosclerotic plaque instability and thrombus formation and may precipitate type 1 MI. Patients with severe disease often show decrease in platelets count, higher levels of d-dimer, ultralarge von Willebrand factor multimers, tissue factor, and prolongation of prothrombin time, which reflects a prothrombotic state. An endothelial dysfunction has been described as a consequence of the direct viral effects and of the hyperinflammatory environment. The expression of tissue factor, von Willebrand factor, thromboxane, and plasminogen activator inhibitor-1 promotes the prothrombotic status. In addition, endothelial cells generate superoxide anions, with enhanced local oxidative stress, and endothelin-1, which affects the vasodilator/vasoconstrictor balance and platelet aggregation. The optimal management of COVID-19 patients is a challenge both for logistic and clinical reasons. A deeper understanding of ACS pathophysiology may yield novel research insights and therapeutic perspectives in higher cardiovascular risk subjects with COVID-19.
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Chew NWS, Ow ZGW, Teo VXY, Heng RRY, Ng CH, Lee CH, Low AF, Chan MYY, Yeo TC, Tan HC, Loh PH. The Global Effect of the COVID-19 Pandemic on STEMI Care: A Systematic Review and Meta-analysis. Can J Cardiol 2021; 37:1450-1459. [PMID: 33848599 PMCID: PMC8056787 DOI: 10.1016/j.cjca.2021.04.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has affected patients with ST-segment elevation myocardial infarction (STEMI) requiring primary percutaneous coronary intervention (PCI) worldwide. In this review we examine the global effect of the COVID-19 pandemic on incidence of STEMI admissions, and relationship between the pandemic and door to balloon time (D2B), all-cause mortality, and other secondary STEMI outcomes. METHODS We performed a systematic review and meta-analysis to primarily compare D2B time and in-hospital mortality of STEMI patients who underwent primary PCI during and before the pandemic. Subgroup analyses were performed to investigate the influence of geographical region and income status of a country on STEMI care. An online database search included studies that compared the aforementioned outcomes of STEMI patients during and before the pandemic. RESULTS In total, 32 articles were analyzed. Overall, 19,140 and 68,662 STEMI patients underwent primary PCI during and before the pandemic, respectively. Significant delay in D2B was observed during the pandemic (weighted mean difference, 8.10 minutes; 95% confidence interval [CI], 3.90-12.30 minutes; P = 0.0002; I2 = 90%). In-hospital mortality was higher during the pandemic (odds ratio [OR], 1.27; 95% CI, 1.09-1.49; P = 0.002; I2 = 36%), however this varied with factors such as geographical location and income status of a country. Subgroup analysis showed that low-middle-income countries observed a higher rate of mortality during the pandemic (OR, 1.52; 95% CI, 1.13-2.05; P = 0.006), with a similar but insignificant trend seen among the high income countries (OR, 1.17; 95% CI, 0.95-1.44; P = 0.13). CONCLUSIONS The COVID-19 pandemic is associated with worse STEMI performance metrics and clinical outcome, particularly in the Eastern low-middle-income status countries. Better strategies are needed to address these global trends in STEMI care during the pandemic.
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Affiliation(s)
- Nicholas W S Chew
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore.
| | | | - Vanessa Xin Yi Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ryan Rui Yang Heng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Adrian F Low
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark Yan-Yee Chan
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Huay-Cheem Tan
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Poay-Huan Loh
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Abate SM, Mantefardo B, Nega S, Chekole YA, Basu B, Ali SA, Taddesse M. Global burden of acute myocardial injury associated with COVID-19: A systematic review, meta-analysis, and meta-regression. Ann Med Surg (Lond) 2021; 68:102594. [PMID: 34336202 PMCID: PMC8316689 DOI: 10.1016/j.amsu.2021.102594] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/16/2021] [Accepted: 07/25/2021] [Indexed: 12/12/2022] Open
Abstract
Background The body of evidence showed that there is a strong correlation between acute myocardial Injury and COVID-19 infection. However, the link between acute myocardial infection and COVID-19, the prevalence, reliability of diagnostic modalities, independent predictors, and clinical outcomes are still uncertain and a topic of debate. The current study was designed to determine the prevalence, determinants, and outcomes of acute myocardial injury based on a systematic review and meta-analysis the global published peer-reviewed works of literature. Methods A comprehensive search was conducted in PubMed/Medline; Science direct, CINHAL, and LILACS from December 2019 to May 2021. All observational studies reporting the prevalence of AMI were included while case reports and reviews were excluded. The data were extracted with two independent authors in a customized format. The methodological quality of included studies was evaluated using the Newcastle-Ottawa appraisal tool. Results A total of 397 articles were identified from different databases. Thirty-seven Articles with 21, 204 participants were included while seven studies were excluded. The meta-analysis revealed that the pooled prevalence of myocardial injury during the COVID-19 pandemic was 22.33 % (95 % CI: 17.86 to 26.81, 37). Conclusion Our meta-analysis showed that mortality among patients with an acute myocardial injury during COVID-19 was more than four times more likely as compared to those without AMI. This necessitates a mitigating strategy to prevent and manage before its clinical outcomes getting worse.
The meta-analysis revealed that more than one-fifth of patients with COVID-19 sustained AMI ∙The incidence of mortality among patients with AMI during COVID-19 pandemic was four times more likely as compared those without AMI ∙Prevalence of AMI was three times more likely in patients with history of Coronary artery disease ∙Smoking and hypertension were the independent predictors of acute myocardial Injury
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Affiliation(s)
- Semagn Mekonnen Abate
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Bahiru Mantefardo
- Departemnt of Internal Medicine, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Solomon Nega
- Departemnt of Internal Medicine, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Yigrem Ali Chekole
- Departemnt of Psychiatry, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Bivash Basu
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Siraj Ahmed Ali
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Moges Taddesse
- Public Health, College of Health Sciences and Medicine, Dilla University, Ethiopia
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Talebi S, Jadhav P, Tamis-Holland JE. Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease (MINOCA): a Review of the Present and Preview of the Future. Curr Atheroscler Rep 2021; 23:49. [PMID: 34226967 PMCID: PMC8257265 DOI: 10.1007/s11883-021-00945-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The syndrome of myocardial infarction in the absence of obstructive coronary artery disease (MINOCA) is not uncommon and has multiple potential coronary etiologies. With the use of more sensitive cardiac biomarkers and advanced cardiovascular imaging, MINOCA presentations have gain increasing attention among researchers and cardiologists. Despite the presence of a myocardial infarction and elevated future risk, many patients are sent home with little or no cardio-protective treatment and no explanation for their symptoms. In this review, we emphasized the importance of MINOCA treatment based on the underlying etiology. RECENT FINDINGS As there are multiple pathophysiological mechanisms potentially involved in MINOCA, it should be considered a working diagnosis until there is a better understanding regarding the underlying cause. It is critical to use multimodality imaging when treating patients with MINOCA to help determine the underlying etiology and rule out mimics of MINOCA, so that therapies appropriate to the etiology can be provided. A more systematic approach to managing patients with MINOCA should result in better treatment and an improved prognosis for these patients.
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Affiliation(s)
- Soheila Talebi
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, 1111 Avenue New York, Amsterdam, NY 10025 USA
| | - Preeti Jadhav
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, 1111 Avenue New York, Amsterdam, NY 10025 USA
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Flattening the other curve: Reducing emergency department STEMI delays during the COVID-19 pandemic. Am J Emerg Med 2021; 49:367-372. [PMID: 34246966 PMCID: PMC8254397 DOI: 10.1016/j.ajem.2021.06.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 02/06/2023] Open
Abstract
Background The COVID-19 pandemic has been associated with ST-Elevation Myocardial Infarction (STEMI) reperfusion delays despite reduced emergency department (ED) volumes. However, little is known about ED contributions to these delays. We sought to measure STEMI delays and ED quality benchmarks over the course of the first two waves of the pandemic. Study This study was a multi-centre, retrospective chart review from two urban, academic medical centres. We obtained ED volumes, COVID-19 tests and COVID-19 cases from the hospital databases and ED Code STEMIs with culprit lesions from the cath lab. We measured door-to-ECG (DTE) time and ECG-to-Activation (ETA) time during the phases of the pandemic in our jurisdiction: pre-first wave (Jan-Mar 2020), first wave (Apr-June 2020), post-first wave (July-Nov 2020), and second wave (Dec 2020 to Feb 2021). We calculated median DTE and ETA times and compared them to the 2019 baseline using Wilcox rank-sum test. We calculated the percentages of DTE ≤10 min and of ETA ≤10 min and compared them to baseline using chi-square test. We also utilized Statistical Process Control (SPC) Xbar-R charts to assess for special cause variation. Results COVID-19 cases began during the pre-wave phase, but there was no change in ED volumes or STEMI quality metrics. During the first wave ED volumes fell by 40%, DTE tripled (10.0 to 29.5 min, p = 0.016), ETA doubled (8.5 to 17.0 min, p = 0.04), and percentages for both DTE ≤10 min and ETA ≤10 min fell by three-quarters (each from more than 50%, to both 12.5%, both p < 0.05). After the first wave all STEMI quality benchmarks returned to baseline and did not significantly change during the second wave. A brief period of special cause variation was noted for DTE during the first wave. Conclusions Both DTE and ETA metrics worsened during the first wave of the pandemic, revealing how it negatively impacted the triage and diagnosis of STEMI patients. But these normalized after the first wave and were unaffected by the second wave, indicating that nurses and physicians adapted to the pandemic to maintain STEMI quality of care. DTE and ETA metrics can help EDs identify delays to reperfusion during the pandemic and beyond.
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Foret T, Dufrost V, Salomon Du Mont L, Costa P, Lefevre B, Lacolley P, Regnault V, Zuily S, Wahl D. Systematic Review of Antiphospholipid Antibodies in COVID-19 Patients: Culprits or Bystanders? Curr Rheumatol Rep 2021; 23:65. [PMID: 34218350 PMCID: PMC8254447 DOI: 10.1007/s11926-021-01029-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW COVID-19 patients have a procoagulant state with a high prevalence of thrombotic events. The hypothesis of an involvement of antiphospholipid antibodies (aPL) has been suggested by several reports. Here, we reviewed 48 studies investigating aPL in COVID-19 patients. RECENT FINDINGS Prevalence of Lupus Anticoagulant (LA) ranged from 35% to 92% in ICU patients. Anti-cardiolipin (aCL) IgG and IgM were found in up to 52% and up to 40% of patients respectively. Anti-β2-glycoprotein I (aβ2-GPI) IgG and IgM were found in up to 39% and up to 34% of patients respectively. Between 1% and 12% of patients had a triple positive aPL profile. There was a high prevalence of aβ2-GPI and aCL IgA isotype. Two cohort studies found few persistent LA but more persistent solid phase assay aPL over time. aPL determination and their potential role is a real challenge for the treatment of this disease.
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Affiliation(s)
- Thomas Foret
- Université de Lorraine, INSERM, DCAC, F-54000, Nancy, France
| | - Virginie Dufrost
- Université de Lorraine, INSERM, DCAC, F-54000, Nancy, France
- CHRU-Nancy, Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, F-54000, Nancy, France
| | - Lucie Salomon Du Mont
- CHRU-Besancon, Vascular and Endovascular Surgery Department, F-25000, Besancon, France
- Université de Bourgogne Franche-Comté, EA3920, F-25000, Besancon, France
| | - Patricia Costa
- CHRU-Besancon, Vascular Medicine Unit, Vascular and Endovascular Surgery Department, F-25000, Besancon, France
| | - Benjamin Lefevre
- Université de Lorraine, CHRU-Nancy, Infectious and Tropical Diseases, F-54000, Nancy, France
- Université de Lorraine, APEMAC, F-54000, Nancy, France
| | | | | | - Stephane Zuily
- Université de Lorraine, INSERM, DCAC, F-54000, Nancy, France
- CHRU-Nancy, Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, F-54000, Nancy, France
| | - Denis Wahl
- Université de Lorraine, INSERM, DCAC, F-54000, Nancy, France.
- CHRU-Nancy, Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, F-54000, Nancy, France.
- INSERM UMR_S 1116 DCAC and CHRU-Nancy, Vascular Medicine Division and Regional Competence Center for Rare Auto-Immune Vascular Diseases, University of Lorraine, INSERM, University Hospital (CHRU) of Nancy, Nancy, France.
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Kamarullah W, Sabrina AP, Rocky MA, Gozali DR. Investigating the implications of COVID-19 outbreak on systems of care and outcomes of STEMI patients: A systematic review and meta-analysis. Indian Heart J 2021; 73:404-412. [PMID: 34474750 PMCID: PMC8257902 DOI: 10.1016/j.ihj.2021.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/20/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION There has been a concern whether the decrease in ST-segment elevation myocardial infarction (STEMI) cases during the COVID-19 pandemic era is related to unsatisfactory performance of STEMI systems of care as well as worsening of the clinical outcomes in STEMI patients. Thus, our meta-analysis was conducted to evaluate this matter. METHODS We compared the predetermined variables in this meta-analysis during the early and late pandemic. Using a combination of adapted search terms to fit the requirements of several search engines (PubMed, EuropePMC, SCOPUS, ProQuest, and EBSCOhost), we reviewed all observational studies citing our outcomes of interest before and during the outbreak. RESULTS Thirty-five records comprising a total of 62,247 participants were identified. Overall, our meta-analysis showed that there was a huge reduction of nearly 80% for STEMI admission during the outbreak (n = 10,263) in contrast to before the outbreak period (n = 51,984). STEMI patients who were admitted during the outbreak received less primary PCI and had longer symptom-to-FMC (first medical contact) time along with prolonged door-to-balloon (DTB) time. A decrease in the achievement of final TIMI (thrombolysis in myocardial infarction) 3 flow after primary PCI was also observed in this study. However, the number of in-hospital mortality was similar between two groups. CONCLUSION There was a decrease in the STEMI care performance and worsening of clinical outcomes in STEMI patients, especially in the early pandemic period. Overall, concise health services must be implemented following a responsibility to obey health protocols to deliver high-quality services related to STEMI systems of care amidst the global pandemic.
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Affiliation(s)
- William Kamarullah
- Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.
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Favaloro EJ, Henry BM, Lippi G. COVID-19 and Antiphospholipid Antibodies: Time for a Reality Check? Semin Thromb Hemost 2021; 48:72-92. [PMID: 34130340 DOI: 10.1055/s-0041-1728832] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Antiphospholipid antibodies (aPL) comprise a panel of autoantibodies that reflect a potential prothrombotic risk in several autoimmune conditions, most notably antiphospholipid (antibody) syndrome (APS). aPL can be divided into those that form part of the laboratory criteria for APS, namely, lupus anticoagulant (LA), as well as anticardiolipin antibodies (aCL) and anti-β2-glycoprotein I antibodies (aβ2GPI) of the immunoglobulin G and M classes, and those that form a group considered as "noncriteria antibodies." The noncriteria antibodies include, for example, antiphosphatidylserine antibodies (aPS), antiprothrombin antibodies (aPT), and antiphosphatidylserine/prothrombin complex antibodies (aPS/PT). COVID-19 (coronavirus disease 2019) represents a prothrombotic disorder, and there have been several reports of various aPL being present in COVID-19 patients. There have also been similarities drawn between some of the pathophysiological features of COVID-19 and APS, in particular, the most severe form, catastrophic APS (CAPS). In this review, we critically appraise the literature on aPL and COVID-19. This is a companion piece to a separate review focused on LA. In the current review, we primarily concentrate on the so-called solid phase identifiable aPL, such as aCL and aβ2GPI, but also reflect on noncriteria aPL. We conclude that aPL positivity may be a feature of COVID-19, at least in some patients, but in general, identified "solid-phase" aPL are of low titer and not able to be well-linked to the thrombotic aspects of COVID-19. Also, most publications did not assess for aPL persistence, and where persistence was checked, the findings appeared to represent transient aPL. Importantly, high-titer aPL or multiple aPL positivity (including double, triple) were in the minority of COVID-19 presentations, and thus discount any widespread presence of APS, including the most severe form CAPS, in COVID-19 patients.
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Affiliation(s)
- Emmanuel J Favaloro
- Department of Haematology, Sydney Centres for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia.,School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Brandon Michael Henry
- Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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Manolis AS, Manolis AA, Manolis TA, Melita H. COVID-19 and Acute Myocardial Injury and Infarction: Related Mechanisms and Emerging Challenges. J Cardiovasc Pharmacol Ther 2021; 26:399-414. [PMID: 33949887 DOI: 10.1177/10742484211011026] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In the era of the coronavirus disease 2019 (COVID-19) pandemic, acute cardiac injury (ACI), as reflected by elevated cardiac troponin above the 99th percentile, has been observed in 8%-62% of patients with COVID-19 infection with highest incidence and mortality recorded in patients with severe infection. Apart from the clinically and electrocardiographically discernible causes of ACI, such as acute myocardial infarction (MI), other cardiac causes need to be considered such as myocarditis, Takotsubo syndrome, and direct injury from COVID-19, together with noncardiac conditions, such as pulmonary embolism, critical illness, and sepsis. Acute coronary syndromes (ACS) with normal or near-normal coronary arteries (ACS-NNOCA) appear to have a higher prevalence in both COVID-19 positive and negative patients in the pandemic compared to the pre-pandemic era. Echocardiography, coronary angiography, chest computed tomography and/or cardiac magnetic resonance imaging may render a correct diagnosis, obviating the need for endomyocardial biopsy. Importantly, a significant delay has been recorded in patients with ACS seeking advice for their symptoms, while their routine care has been sharply disrupted with fewer urgent coronary angiographies and/or primary percutaneous coronary interventions performed in the case of ST-elevation MI (STEMI) with an inappropriate shift toward thrombolysis, all contributing to a higher complication rate in these patients. Thus, new challenges have emerged in rendering a diagnosis and delivering treatment in patients with ACI/ACS in the pandemic era. These issues, the various mechanisms involved in the development of ACI/ACS, and relevant current guidelines are herein reviewed.
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Affiliation(s)
- Antonis S Manolis
- First Department of Cardiology, 68989Athens University School of Medicine, Athens, Greece
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Garcia S, Dehghani P, Grines C, Davidson L, Nayak KR, Saw J, Waksman R, Blair J, Akshay B, Garberich R, Schmidt C, Ly HQ, Sharkey S, Mercado N, Alfonso CE, Misumida N, Acharya D, Madan M, Hafiz AM, Javed N, Shavadia J, Stone J, Alraies MC, Htun W, Downey W, Bergmark BA, Ebinger J, Alyousef T, Khalili H, Hwang CW, Purow J, Llanos A, McGrath B, Tannenbaum M, Resar J, Bagur R, Cox-Alomar P, Stefanescu Schmidt AC, Cilia LA, Jaffer FA, Gharacholou M, Salinger M, Case B, Kabour A, Dai X, Elkhateeb O, Kobayashi T, Kim HH, Roumia M, Aguirre FV, Rade J, Chong AY, Hall HM, Amlani S, Bagherli A, Patel RAG, Wood DA, Welt FG, Giri J, Mahmud E, Henry TD. Initial Findings From the North American COVID-19 Myocardial Infarction Registry. J Am Coll Cardiol 2021; 77:1994-2003. [PMID: 33888249 PMCID: PMC8054772 DOI: 10.1016/j.jacc.2021.02.055] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has impacted many aspects of ST-segment elevation myocardial infarction (STEMI) care, including timely access to primary percutaneous coronary intervention (PPCI). OBJECTIVES The goal of the NACMI (North American COVID-19 and STEMI) registry is to describe demographic characteristics, management strategies, and outcomes of COVID-19 patients with STEMI. METHODS A prospective, ongoing observational registry was created under the guidance of 3 cardiology societies. STEMI patients with confirmed COVID+ (group 1) or suspected (person under investigation [PUI]) (group 2) COVID-19 infection were included. A group of age- and sex-matched STEMI patients (matched to COVID+ patients in a 2:1 ratio) treated in the pre-COVID era (2015 to 2019) serves as the control group for comparison of treatment strategies and outcomes (group 3). The primary outcome was a composite of in-hospital death, stroke, recurrent myocardial infarction, or repeat unplanned revascularization. RESULTS As of December 6, 2020, 1,185 patients were included in the NACMI registry (230 COVID+ patients, 495 PUIs, and 460 control patients). COVID+ patients were more likely to have minority ethnicity (Hispanic 23%, Black 24%) and had a higher prevalence of diabetes mellitus (46%) (all p < 0.001 relative to PUIs). COVID+ patients were more likely to present with cardiogenic shock (18%) but were less likely to receive invasive angiography (78%) (all p < 0.001 relative to control patients). Among COVID+ patients who received angiography, 71% received PPCI and 20% received medical therapy (both p < 0.001 relative to control patients). The primary outcome occurred in 36% of COVID+ patients, 13% of PUIs, and 5% of control patients (p < 0.001 relative to control patients). CONCLUSIONS COVID+ patients with STEMI represent a high-risk group of patients with unique demographic and clinical characteristics. PPCI is feasible and remains the predominant reperfusion strategy, supporting current recommendations.
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Affiliation(s)
- Santiago Garcia
- Minneapolis Heart Institute Foundation. Minneapolis, Minnesota, USA.
| | | | - Cindy Grines
- Northside Cardiovascular Institute, Atlanta, Georgia, USA; Society for Cardiovascular Angiography and Interventions, Washington, DC, USA
| | - Laura Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Keshav R Nayak
- Department of Cardiology, Scripps Mercy Hospital, San Diego, California, USA
| | - Jacqueline Saw
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Ron Waksman
- MedStar Washington Hospital Center, Washington, DC, USA
| | - John Blair
- University of Chicago, Chicago, Illinois, USA
| | - Bagai Akshay
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ross Garberich
- Minneapolis Heart Institute Foundation. Minneapolis, Minnesota, USA
| | | | - Hung Q Ly
- University of Montreal, Montreal, Quebec, Canada
| | - Scott Sharkey
- Minneapolis Heart Institute Foundation. Minneapolis, Minnesota, USA
| | | | | | | | - Deepak Acharya
- University of Arizona Sarver Heart Center, Tucson, Arizona, USA
| | - Mina Madan
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Abdul Moiz Hafiz
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Nosheen Javed
- Southcoast Health System, New Bedford, Massachusetts, USA
| | - Jay Shavadia
- Royal University Hospital, Saskatchewan Health, Saskatoon, Saskatchewan, Canada
| | - Jay Stone
- Community Medical Center, RWJ Barnabas Health, Toms River, New Jersey, USA
| | | | - Wah Htun
- Gundersen Health System, La Crosse, Wisconsin, USA
| | - William Downey
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Brian A Bergmark
- TIMI Study Group, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jospeh Ebinger
- Cedars Sinai Heart Institute, Los Angeles, California, USA
| | - Tareq Alyousef
- Cook County Health and Hospitals System, Chicago, Illinois, USA
| | - Houman Khalili
- Delray Medical Center, Tenet Healthcare, Delray Beach, Florida, USA
| | - Chao-Wei Hwang
- Frederick Health Hospital, Frederick, Maryland, USA; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joshua Purow
- Holy Cross Hospital, Fort Lauderdale, Florida, USA
| | | | - Brent McGrath
- Horizon Health Network, Saint John, New Brunswick, Canada
| | | | - Jon Resar
- Frederick Health Hospital, Frederick, Maryland, USA, and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rodrigo Bagur
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | | | | | | | | | | | | | - Brian Case
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Ameer Kabour
- Mercy St. Vincent's Medical Center, Toledo, Ohio, USA
| | - Xuming Dai
- NewYork-Presbyterian Queens, Flushing, New York, USA
| | | | | | - Hahn-Ho Kim
- St. Mary's General Hospital, Kitchener, Ontario, Canada
| | - Mazen Roumia
- St. Vincent Hospital, Worcester, Massachusetts, USA
| | - Frank V Aguirre
- Prairie Heart Institute at HSHS St. John's Hospital, Springfield, Illinois, USA
| | - Jeffrey Rade
- UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Aun-Yeong Chong
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Hurst M Hall
- UT Southwestern Medical Center, Dallas, Texas, USA
| | - Shy Amlani
- William Osler Health System, Brampton, Ontario, Canada
| | | | | | - David A Wood
- Canadian Association of Interventional Cardiology, Ottawa, Ontario, Canada
| | - Frederick G Welt
- American College of Cardiology Interventional Cardiology Section Leadership Council, Washington, DC, USA; University of Utah Health Sciences, Salt Lake City, Utah, USA
| | - Jay Giri
- University of Pennsylvania, Philadelphia, Pennsylvania, USA. https://twitter.com/jaygirimd
| | - Ehtisham Mahmud
- Sulpizio Cardiovascular Center, University of California San Diego, La Jolla, California, USA
| | - Timothy D Henry
- Carl and Edyth Lindner Center for Research and Education, the Christ Hospital, Cincinnati, Ohio, USA. https://twitter.com/HenrytTimothy
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Eroglu SE, Ademoglu E, Bayram S, Aksel G. A Rare Cause of ST-Segment Elevation Myocardial Infarction in COVID-19: MINOCA Syndrome. Medeni Med J 2021; 36:63-68. [PMID: 33828892 PMCID: PMC8020180 DOI: 10.5222/mmj.2021.25478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 02/28/2021] [Indexed: 12/11/2022] Open
Abstract
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is defined as having a stenosis of less than 50% or no stenosis in coronary angiography in a patient diagnosed with myocardial infarction. Because of its thrombogenic predisposition in COVID-19, the diagnosis of MINOCA syndrome is rarely thought in the patients with ST-segment elevation myocardial Infarction on electrocardiogram. In this case report, we discuss a 47-year-old male patient diagnosed with MINOCA who was followed up with respiratory failure due to COVID-19 viral pneumonia in intensive care unit. His 12-lead electrocardiogram showed “inferior STEMI”. A 30-40% stenosis was also shown in the midportion of left anterior descending artery in emergency coronary angiography. The patient had a normal computed tomographic pulmonary angiography and was discharged with a full recovery. MINOCA may be triggered by hyperinflammation or various processes due to COVID-19. To explain these processes associated with MINOCA syndrome, further clinical trials are needed.
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Affiliation(s)
- Serkan Emre Eroglu
- Health Sciences University, Umraniye Research and Training Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Enis Ademoglu
- Health Sciences University, Umraniye Research and Training Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Samet Bayram
- Health Sciences University, Umraniye Research and Training Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Gökhan Aksel
- Health Sciences University, Umraniye Research and Training Hospital, Department of Emergency Medicine, Istanbul, Turkey
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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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Kiss P, Carcel C, Hockham C, Peters SAE. The impact of the COVID-19 pandemic on the care and management of patients with acute cardiovascular disease: a systematic review. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:18-27. [PMID: 33151274 PMCID: PMC7665454 DOI: 10.1093/ehjqcco/qcaa084] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023]
Abstract
Background The COVID-19 pandemic has disrupted healthcare services around the world, which may have serious implications for the prognosis of patients with acute cardiovascular disease. We conducted a systematic review to assess the extent to which health services related to the care and management of acute cardiovascular events have been impacted during the COVID-19 pandemic. Methods PubMed, MedRxiv and Google Scholar were searched for observational studies published up to August 12, 2020 for studies that assessed the impact of the pandemic on the care and management of people with acute CVD. Results In total, 27 articles were included. Of these, 16 examined the impact on acute coronary syndromes (ACS), eight on strokes, one on ACS and strokes, and 2 on other types of CVD. When comparing the COVID-19 period to non-COVID-19 periods, eleven studies observed a decrease in ACS admissions ranging between 40 and 50% and five studies showed a decrease in stroke admissions of between 12 and 40%. Four studies showed a larger reduction in non-ST-segment elevation myocardial infarctions (NSTEMI) compared to ST-segment elevation myocardial infarctions (STEMI). A decrease in the number of reperfusion procedures, a shortening in the lengths of stay at the hospital, and longer symptom-to-door times were also observed. Conclusions The COVID-19 pandemic has led to a substantial decrease in the rate of admissions for acute CVD, reductions in the number of procedures, shortened lengths of stay at the hospital and longer delays between the onset of the symptoms and hospital treatment. The impact on patient’s prognosis needs to be quantified in future studies.
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Affiliation(s)
- Pauline Kiss
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Cheryl Carcel
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Carinna Hockham
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.,The George Institute for Global Health, UNSW, Sydney, Australia.,The George Institute for Global Health, Imperial College London, London, UK
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48
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El Hasbani G, Taher AT, Jawad A, Uthman I. COVID-19, Antiphospholipid Antibodies, and Catastrophic Antiphospholipid Syndrome: A Possible Association? CLINICAL MEDICINE INSIGHTS. ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2020; 13:1179544120978667. [PMID: 33328777 PMCID: PMC7720319 DOI: 10.1177/1179544120978667] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/13/2020] [Indexed: 01/08/2023]
Abstract
Since the 2019 novel coronavirus (COVID-19) was first detected in December 2019, research on the complications and fatality of this virus has hastened. Initially, case reports drew an association between COVID-19 and abnormal coagulation parameters. Subsequently, cross-sectional studies found a high prevalence of thrombosis among ICU and non-ICU COVID-19 patients. For that reason, certain studies tried to explain the pathogenic mechanisms of thrombosis, one of which was the emergence of anti-phospholipid antibodies (aPL). Although aPL have been found positive in very few patients, their association with thrombotic events stays debatable. Given the thrombotic manifestations of COVID-19 and the potential role of aPL, the catastrophic form of APS (CAPS) might be a major fatal phenomenon. However, to date, there has been no clear association of CAPS to COVID-19. Moreover, since infections, including viral respiratory similar to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are considered main etiologies for CAPS, it could be possible that SARS-CoV-2 can induce CAPS although no evidence is currently found. High quality studies are needed to develop a clear idea on the pathogenic role of aPL in the progression of thrombosis in COVID-19 patients, and how such patients could be fit into a thromboprophylaxis plan.
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Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Jawad
- Department of Rheumatology, The Royal London Hospital, Bancroft Road, London, UK
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Kaddoura R, Salam AM. Thrombosis Management and Challenges in COVID-19 Patients Presenting with Acute Coronary Syndromes. Heart Views 2020; 21:195-208. [PMID: 33688412 PMCID: PMC7898995 DOI: 10.4103/heartviews.heartviews_143_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 01/08/2023] Open
Abstract
Thrombotic complications in patients with coronavirus disease 2019 (COVID-19) infection have been increasingly recognized, particularly those affecting the cardiovascular system. Patients with COVID-19 infection can suffer from increased coagulopathy as well as myocardial injury. In this review, we discuss these complications with special focus on management challenges in patients with acute coronary disease based on the available evidence from published literature.
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Affiliation(s)
- Rasha Kaddoura
- Department of Cardiology and Cardiovascular Surgery,Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Amar M Salam
- Department of Cardiology, Al Khor Hospital, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, QU Health, Qatar University, Doha, Qatar
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