Abstract
The outbreak of coronavirus disease 2019 (COVID-19) has rapidly become a worldwide pandemic. On top of respiratory complications, COVID-19 is associated with major direct and indirect cardiovascular consequences, with the latter probably being even more relevant, especially in the setting of time-dependent cardiovascular emergencies. A growing amount of data suggests a dramatic decline in hospital admissions for acute myocardial infarction (AMI) worldwide during the COVID-19 pandemic, mostly since patients did not activate emergency medical systems because hospitals were perceived as dangerous places regarding the infection risk. Moreover, during the COVID-19 pandemic, patients with AMI had a significantly higher in-hospital mortality compared to those admitted before COVID-19, potentially due to late arrival to the hospital. Finally, no consensus has been reached regarding the most adequate healthcare management pathway for AMI and shared guidance on how to handle patients with AMI during the pandemic is still needed. In this review, we will provide an update on epidemiology, clinical characteristics, and outcomes of patients with AMI during the COVID-19 pandemic, with a special focus on its collateral cardiac impact.
Highlights
Coronavirus disease 2019 (COVID-19), a novel viral respiratory illness due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), became a global pandemic in 2020 [1]
These indirect effects of the pandemic have negatively affected the outcomes of patients with acute myocardial infarction (AMI), regardless of whether they were affected by SARS-CoV-2 infection or not
We will provide an update on epidemiology, clinical characteristics, and outcomes of patients with AMI during the COVID-19 pandemic, with a special focus on its collateral impact on AMI
Summary
Coronavirus disease 2019 (COVID-19), a novel viral respiratory illness due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), became a global pandemic in 2020 [1]. The tremendous pressure exerted on the healthcare system by the viral pandemic compromised proven therapies for acute cardiovascular emergencies, such as AMI [7, 8] Another serious issue during the COVID-19 outbreak has been the reluctance of patients with chest pain to go to the hospital due to the fear of viral infection, even to the point of not seeking care at all or late in the course of AMI [9,10,11]. Viral infections have been shown to activate inflammatory cells of the coronary plaque and to upregulate metalloproteinases and peptidases, which, in turn, may disrupt plaque cap exposing the highly thrombogenic core to the blood [13] Another potential mechanism is the mismatch between reduced oxygen supply and increased myocardial oxygen demand due to sympathetic system activation, tachycardia, hypotension, and hypoxemia in the setting of acute respiratory insufficiency, which may be responsible for Type 2 AMI [14]. A Spanish report compared the activity of 81 ICCU a week before the pandemic with
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