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April 20, 2020

Multisociety Consensus Statement Focuses on Management of AMI Patients During COVID-19

April 20, 2020—The American College of Cardiology (ACC) announced the publication of a consensus statement from ACC, the Society for Cardiovascular Angiography and Interventions, and the American College of Emergency Physicians that outlines recommendations for a systematic approach for the care of patients with acute myocardial infarction (AMI) during the COVID-19 pandemic. The document by Ehtisham Mahmud, MD, et al is available online in Journal of the American College of Cardiology.

According to ACC, the statement advised that during the COVID-19 pandemic, percutaneous coronary intervention (PCI) remains the standard of care for ST-segment elevation myocardial infarction (STEMI) patients at PCI-capable hospitals when it can be provided in a timely fashion, with an expert care team outfitted with personal protection equipment (PPE) and in a dedicated cardiac catheterization laboratory.

As noted by ACC, Dr. Mahmud highlights two major challenges in providing recommendations for AMI care during the COVID-19 pandemic:

  1. Cardiovascular manifestations of COVID-19 are complex with patients presenting with AMI, myocarditis simulating a STEMI presentation, stress cardiomyopathy, nonischemic cardiomyopathy, coronary spasm, or nonspecific myocardial injury.
  2. The prevalence of the COVID-19 disease in the United States population remains unknown and there is the risk of asymptomatic spread.

Considering these challenges, the statement recommends:

  • Informing the public that PCI-capable hospitals can minimize exposure to the coronavirus and the public should continue to call the Emergency Medical System for acute ischemic heart disease symptoms to receive the appropriate level of cardiac care that their presentation warrants.
  • Targeting the use of primary PCI or fibrinolysis (at referral or non-PCI capable hospitals) in patients with STEMI, aiming to avoid reperfusion therapy for those with other causes of ST-segment elevation on the electrocardiogram, and maximizing the safety of the health care team through the appropriate masking of patients and the use of PPE.

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