Abstract
There is no doubt that in the last 2 months during COVID-19 pandemic a smaller number of ST-elevation Myocardial Infarction (STEMI) and Stroke arrived to cardiological and neurological departments. The pathophysiology of STEMI in COVID-19 women is not fully understood; it could be thrombus recanalization, catecholamine storm or Type 2 Myocardial infarction in case of severe respiratory distress or direct myocardial damage (viral myocarditis). Because most of them have normal coronary arteries an invasive strategy with coronary angiography is important to rule out atherosclerotic severe coronary disease.
Highlights
The data on this, at least for ST-elevation Myocardial Infarction (STEMI) are confirmed in most of the countries: the reduction varies from 15 up to 50% [1,2]
This is corroborated by data reporting an increase in late complications of STEMI that we were not used to see anymore: thick intracoronary thrombi, left ventricle or papillary muscle rupture, intraventricular thrombus
A further explanation could be the reduction in the trigger for ischemic events: less travels, less work stress, lower pollution difficult to quantify. How these considerations apply to women and STEMI during COVID-19 pandemic? We know that the number of affected cases is the same in males and females (Global Health 5050) with some variations between countries
Summary
The data on this, at least for STEMI are confirmed in most of the countries: the reduction varies from 15 up to 50% [1,2]. Most Cardiology Societies and Interventional Cardiologists are ascribing this phenomenon to the fear of patients to be infected when coming to casualty departments. This is corroborated by data reporting an increase in late complications of STEMI that we were not used to see anymore: thick intracoronary thrombi (high thrombotic burden), left ventricle or papillary muscle rupture, intraventricular thrombus. Fear of infection cannot be the only explanation because this reduction occurs in country where lock down and the diffuse anxiety toward the infection were not applied, like Sweden
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