Abstract 16323: Ruling Out Sars-cov-2 Infection With a Fast-track 0/1,5-hour Molecular Testing in Patients With Acute Coronary Syndromes

Abstract

Introduction: Timely reperfusion with PCI remains the main goal in STEMI patients. In the Covid 19 period, the fear of contagion reduced the number of hospitalized patients for myocardial infarction, and a substantial delay in the hospitalizations was also observed. The fear of the operators to treat non-tested patients did not facilitate the hospitalization and treatment of ACS patients with suspected Covid-19. Hypothesis: This study aimed to evaluate the feasibility of a fast-tract protocol to rule out SARS-CoV-2 infection in patients with suspected acute coronary syndrome. Methods: In fifty-one patients (mean age 65 ± 12 y) the real-time PCR to extract RNA for SARS-CoV-2 detection was performed with an automated FDA-approved molecular test (Xpert Xpress Cepheid, Sunnyvale, USA). With its 45-minute processing time and with very high sensitivity, this system was tested in patients transferred from spokes centers or from the field to our HUB center. As soon as the patient had arrived in the Cath Lab, the interventional cardiologist, with adequate protection systems, performed the nasopharyngeal swab that was processed with the rapid Cepheid system. In the meanwhile, coronary angiography (CA) or PCI were performed. At the end of the CA/PCI, based on the test response, patients were transferred to the Covid or non Covid areas. Results: The time to perform the nasopharyngeal swab in the cath lab was: 10 + 10 minutes. The time spent to transport the nasopharyngeal test to the laboratory was: 30 + 20 minutes. The time to load 300 ul of biological material and extraction, amplification, and detection of viral nucleic acid, targeting the viral genomic regions N2 and E using the rapid test was 68 + 15 minutes. The result of the test was immediately made readily available through the hospital computer system. The total time from the execution of the nasopharyngeal swab to the result was 109 ± 26 minutes. Conclusions: This study demonstrates the feasibility of a fast-track protocol with a rapid test to ruling out SARS-CoV-2 Infection in ACS. This pathway allows quick patient stratification and it could of particular importance to detect asymptomatic Covid-19 positive patients with ACS.