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Primary PCI Remains Standard of Care for STEMI During COVID-19

When possible, primary PCI should be performed in a timely manner by an expert team equipped with PPE

surgeon

WEDNESDAY, April 29, 2020 (HealthDay News) -- Primary percutaneous coronary intervention (PCI) remains the standard of care for patients with ST-elevation myocardial infarction (STEMI) during the COVID-19 pandemic, according to a consensus statement published online April 20 in the Journal of the American College of Cardiology.

Ehtisham Mahmud, M.D., from the University of California, San Diego, and colleagues provided recommendations for a systematic approach for care of acute myocardial infarction patients during the COVID-19 pandemic. Two major challenges complicate the provision of recommendations for care: cardiovascular manifestations of COVID-19 are complex, and the prevalence of COVID-19 remains unknown.

The authors address care of these patients by focusing on varied clinical presentations; appropriate personal protective equipment (PPE) for health care workers; the role of the emergency department (ED), emergency medical system, and the cardiac catheterization laboratory (CCL); and regional systems of care for STEMI. For patients at hospitals capable of PCI, primary PCI remains the standard of care when it can be provided in a timely manner, with an expert team fitted with PPE in a dedicated CCL room. At hospitals that are not capable of PCI, or in specific situations where primary PCI cannot be executed or is not deemed the best option, a fibrinolysis-based strategy may be considered.

"Clinicians should recognize that patients with COVID-19 are inherently complex: a broad differential diagnosis for ST elevations (including COVID-associated myocarditis) should be considered in the ED prior to choosing a reperfusion strategy," the authors write.

Several authors disclosed ties to the pharmaceutical and medical device industries.

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