Acute Coronary Syndromes and Covid-19: Exploring the Uncertainties.

Marco Schiavone,Giuseppe Biondi-Zoccai,Fabrizio D’Ascenzo,Maurizio Viecca,Massimo Mancone,Cecilia Gobbi,Alessio Gasperetti,Giovanni Battista Forleo,Alberto Palazzuoli,Francesco Fedele,Gianfranco Mitacchione,Massimo Galli

doi:10.3390/jcm9061683

Abstract

Since an association between myocardial infarction (MI) and respiratory infections has been described for influenza viruses and other respiratory viral agents, understanding possible physiopathological links between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and acute coronary syndromes (ACS) is of the greatest importance. The initial data suggest an underestimation of ACS cases all over the world, but acute MI still represents a major cause of morbidity and mortality worldwide and should not be overshadowed during the coronavirus disease (Covid-19) pandemic. No common consensus regarding the most adequate healthcare management policy for ACS is currently available. Indeed, important differences have been reported between the measures employed to treat ACS in China during the first disease outbreak and what currently represents clinical practice across Europe and the USA. This review aims to discuss the pathophysiological links between MI, respiratory infections, and Covid-19; epidemiological data related to ACS at the time of the Covid-19 pandemic; and learnings that have emerged so far from several catheterization labs and coronary care units all over the world, in order to shed some light on the current strategies for optimal management of ACS patients with confirmed or suspected SARS-CoV-2 infection.

Highlights

In December 2019, an outbreak of pneumonia caused by a novel coronavirus occurred in Wuhan, Hubei province, spreading rapidly first throughout China, and subsequently across Europe, the United States (US), and the rest of the world [1,2,3], reaching a total number of 3,435,894 confirmed cases worldwide as of 5 May 2020 [4]
This study demonstrated that myocardial injury was independently associated with an increased risk of mortality in patients with Covid-19
Given the limited heterogeneity of data published in recent months, the potential overlapping symptomatology between acute coronary syndromes (ACS) and severe acute respiratory syndrome (SARS)-CoV-2 infection, and the underestimation of ACS cases during Covid-19 outbreak, more reliable data are needed to estimate the real prevalence of ACS during this pandemic

Summary

Introduction

In December 2019, an outbreak of pneumonia caused by a novel coronavirus occurred in Wuhan, Hubei province, spreading rapidly first throughout China, and subsequently across Europe, the United States (US), and the rest of the world [1,2,3], reaching a total number of 3,435,894 confirmed cases worldwide as of 5 May 2020 [4]. On 30 January 2020, the World Health Organization (WHO) declared the Covid-19 outbreak a public health emergency of international concern, and on 12 March 2020, it was characterized as a pandemic. Patients exposed to this virus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), frequently present with fever, cough, and shortness of breath within 2 to 14 days after exposure, and usually develop coronavirus disease (Covid-19)-related pneumonia [5]. ACS still remain a major cause of morbidity and mortality worldwide and are responsible for more than 1 million hospital admissions in the US annually, while ischemic heart disease accounts for almost 1.8 million annual deaths, or 20% of all deaths in Europe, with large variations between different European countries [9,10]

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