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ST-segment Elevation, Myocardial Injury, and Suspected or Confirmed COVID-19 Patients: Diagnostic and Treatment Uncertainties

      Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 and has resulted in a global pandemic with considerable morbidity and mortality.
      • Yang X.
      • Yu Y.
      • Xu J.
      • et al.
      Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study.
      • Arentz M.
      • Yim E.
      • Klaff L.
      • et al.
      Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington state.
      • Wang D.
      • Hu B.
      • Hu C.
      • et al.
      Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China.
      Multiple studies have noted both increased susceptibility in patients with underlying cardiovascular disease to COVID-19 and severe cardiovascular sequelae in COVID-19–infected patients, including acute myocardial injury, arrhythmias, and shock.
      • Wang D.
      • Hu B.
      • Hu C.
      • et al.
      Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China.
      ,
      • Shi S.
      • Qin M.
      • Shen B.
      • et al.
      Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China.
      In addition, there have been several reports of ST-segment elevation (STE) in patients with COVID-19 who do not have evidence for obstructive coronary artery disease on invasive coronary angiography.
      • Hu H.
      • Ma F.
      • Wei X.
      • Fang Y.
      Coronavirus fulminant myocarditis saved with glucocorticoid and human immunoglobulin.
      ,
      • Inciardi R.M.
      • Lupi L.
      • Zaccone G.
      • et al.
      Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19).
      The effect of “false” catheterization laboratory activation includes multiple inherent risks arising from the following: an invasive arterial procedure and adjunctive antithrombotic administration for these patients; the exposure of personnel during transfers; and possible respiratory failure in patients with COVID-19 and subsequent aerosol-generating procedures during resuscitation and intubation. The downstream effects of inadvertent exposure and contamination may not be trivial and could result in critical isolation of the exposed staff. The potential effects may result in staffing shortages leading to slowed or even closed cardiac catheterization or other cardiac imaging services, especially in smaller facilities. Conversely, it remains critically important to provide timely emergent reperfusion therapy in patients experiencing an acute myocardial infarction (MI) due to acute coronary occlusion.
      • O’Gara P.T.
      • Kushner F.G.
      • Ascheim D.D.
      • et al.
      2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
      Thus, there is an urgent need for an algorithm that facilitates triage of suspected or proven COVID-19 patients with STE toward initial invasive or noninvasive pathways.
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      References

        • Yang X.
        • Yu Y.
        • Xu J.
        • et al.
        Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study.
        ([published online ahead of print February 24, 2020]. Lancet Respir Med)
        • Arentz M.
        • Yim E.
        • Klaff L.
        • et al.
        Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington state.
        ([published online ahead of print March 19, 2020]. JAMA)
        • Wang D.
        • Hu B.
        • Hu C.
        • et al.
        Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China.
        JAMA. 2020; 323: 1061-1069
        • Shi S.
        • Qin M.
        • Shen B.
        • et al.
        Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China.
        ([published online ahead of print March 25, 2020]. JAMA Cardiol)
        • Hu H.
        • Ma F.
        • Wei X.
        • Fang Y.
        Coronavirus fulminant myocarditis saved with glucocorticoid and human immunoglobulin.
        ([published online ahead of print March 16, 2020]. Eur Heart J)
        • Inciardi R.M.
        • Lupi L.
        • Zaccone G.
        • et al.
        Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19).
        ([published online ahead of print March 27, 2020]. JAMA Cardiol)
        • O’Gara P.T.
        • Kushner F.G.
        • Ascheim D.D.
        • et al.
        2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
        J Am Coll Cardiol. 2013; 61: e78-e140
        • Thygesen K.
        • Alpert J.S.
        • Jaffe A.S.
        • et al.
        Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth universal definition of myocardial infarction (2018).
        J Am Coll Cardiol. 2018; 72: 2231-2264
        • Cuervo G.
        • Viasus D.
        • Carratalà J.
        Acute myocardial infarction after laboratory-confirmed influenza infection.
        N Engl J Med. 2018; 378: 2540
        • Vasile V.C.
        • Chai H.S.
        • Khambatta S.
        • Afessa B.
        • Jaffe A.S.
        Significance of elevated cardiac troponin T levels in critically ill patients with acute respiratory disease.
        Am J Med. 2010; 123: 1049-1058
        • Zhou F.
        • Yu T.
        • Du R.
        • et al.
        Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study [published correction appears in Lancet. 2020;395(10229):1038].
        Lancet. 2020; 395: 1054-1062
        • Lippi G.
        • Lavie C.J.
        • Sanchis-Gomar F.
        Cardiac troponin I in patients with coronavirus disease 2019 (COVID-19): evidence from a meta-analysis.
        ([published online ahead of print March 10, 2020]. Prog Cardiovasc Dis)
        • Sandoval Y.
        • Jaffe A.S.
        Type 2 myocardial infarction: JACC Review Topic of the Week.
        J Am Coll Cardiol. 2019; 73: 1846-1860
        • Barnes M.
        • Heywood A.E.
        • Mahimbo A.
        • Rahman B.
        • Newall A.T.
        • Macintyre C.R.
        Acute myocardial infarction and influenza: a meta-analysis of case-control studies.
        Heart. 2015; 101: 1738-1747
        • Corrales-Medina V.F.
        • Madjid M.
        • Musher D.M.
        Role of acute infection in triggering acute coronary syndromes.
        Lancet Infect Dis. 2010; 10: 83-92
        • Warren-Gash C.
        • Smeeth L.
        • Hayward A.C.
        Influenza as a trigger for acute myocardial infarction or death from cardiovascular disease: a systematic review.
        Lancet Infect Dis. 2009; 9: 601-610
        • Szerlip M.
        • Anwaruddin S.
        • Aronow H.D.
        • et al.
        Considerations for cardiac catheterization laboratory procedures during the COVID-19 pandemic perspectives from the Society for Cardiovascular Angiography and Interventions Emerging Leader Mentorship (SCAI ELM) members and graduates.
        ([published online ahead of print March 25, 2020]. Catheter Cardiovasc Interv)
        • Ting H.H.
        • Rihal C.S.
        • Gersh B.J.
        • et al.
        Regional systems of care to optimize timeliness of reperfusion therapy for ST-elevation myocardial infarction: the Mayo Clinic STEMI Protocol.
        Circulation. 2007; 116: 729-736
        • Porter T.R.
        • Mulvagh S.L.
        • Abdelmoneim S.S.
        • et al.
        Clinical applications of ultrasonic enhancing agents in echocardiography: 2018 American Society of Echocardiography Guidelines Update.
        J Am Soc Echocardiogr. 2018; 31: 241-274