Acute coronary syndrome: new realities in the era of the COVID-19 pandemic
Authors:
Company:
1 I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
2 Egor'evsk Central Regional Hospital, Egor'evsk, Moscow Region, Russian Federation
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Type: Reviews
DOI:
For citation: Serebrennikov I.I., Kopylov F.Yu., Komarov R.N., Mukanova M.B., Ismailbaev A.M., Markitan S.V., Gafurov F.S. Acute coronary syndrome: new realities in the era of the COVID-19 pandemic. Creative Cardiology. 2022; 16 (2): 163–78 (in Russ.). DOI: 10.24022/1997-3187-2022-16-2-163-178
Received / Accepted: 30.11.2021 / 25.06.2022
Keywords: COVID-19 acute coronary syndrome diversion of medical resources high rates of morbidity and mortality
Abstract
Coronavirus infection (COVID-19) pandemic is a global health problem associated with high rates of morbidity and mortality. In this difficult time, the topic of acute coronary syndrome (ACS) is complicated by a number of clinically significant issues, such as COVID-induced myocardial damage, uncertainty of this emergency management, the need for a clear optimization of diagnostic and therapeutic measures, as well as ensuring maximum protection of medical personnel. In addition, there is a decrease in the number of hospitalizations for ACS worldwide, which is associated with the reluctance of patients to seek medical help and the redirection of medical resources in favor of combating the pandemic. Given that the primary pathophysiological mechanism of COVID-19 is a significant shift in blood coagulation rates, it is necessary to establish a relationship between this infection and an increased risk of acute coronary disease. The high risk of developing ACS associated with COVID-19 may be associated with atherosclerotic plaque rupture caused by endothelial cell damage, cytokine storms and the patient's inflammatory status. In this review will present aspects of the impact of the COVID-19 pandemic on the diagnosis, clinical course and treatment of ACS, as well as published data on the results of treatment of coronary syndrome in a pandemic.
References
- Ritchie H., Ortiz-Ospina E., Beltekian D., Mathieu E., Hasell J., Macdonald B. et al. Coronavirus Pandemic (COVID-19). 2020. Available at:https://ourworldindata.org/coronavirus (дата обращения 19.05.2022/accessed May 19, 2022).
- Rashid M., Wu J., Timmis A., Curzen N., Clarke S., Zaman A. et al. Outcomes of COVID-19- positive acute coronary syndrome patients: a multisource electronic healthcare records study from England. J. Intern. Med. 2021. DOI: 10.1111/joim.13246
- Montone R.A., Iannaccone G., Meucci M.C., Gurgoglione F., Niccoli G. Myocardial and microvascular injury due to coronavirus disease 2019. Eur. Cardiol. 2020; 15: e52. DOI: 10.15420/ecr. 2020.22
- Bonow R., Fonarow G., O'Gara P., Yancy C. Association of coronavirus disease 2019 (COVID-19) with myocardial injury and mortality. JAMA Cardiol. 2020; 5 (3): 751–3. DOI: 10.1001/jamacardio.2020.1105
- Cameli M., Pastore M., Mandoli G., D'Ascenzi F., Focardi M., Biagioni G. et al. COVID-19 and acute coronary syndromes: current data and future implications. Front. Cardiovasc. Med. 2021; 7: 593496. DOI: 10.3389/fcvm.2020.593496
- De Filippo O., D'Ascenzo F., Angelini F., Bocchino P.P., Conrotto F., Saglietto A. et al. Reduced rate of hospital admissions for acs during Covid-19 outbreak in Northern Italy. N. Engl. J. Med. 2020; 383: 88–9. DOI: 10.1056/NEJMc2009166
- Huang C., Wang Y., Li X., Ren L., Zhao J., Hu Y. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395: 497–506. DOI: 10.1016/S0140-6736(20)30183-5
- Wang D., Hu B., Hu C., Zhu F., Liu X., Zhang J. et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA J. Am. Med. Assoc. 2020; 323: 1061–9. DOI: 10.1001/jama. 2020.1585
- Li B., Yang J., Zhao F., Zhi L., Wang X., Liu L. et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin. Res. Cardiol. 2020; 109: 531–8. DOI: 10.1007/s00392-020-01626-9
- Kang Y., Chen T., Mui D., Ferrari V., Jagasia D., Scherrer-Crosbie M. et al. Cardiovascular manifestations and treatment considerations in covid-19. Heart. 2020; 106: 1132–41. DOI: 10.1136/heartjnl-2020-317056
- Schiavone M., Gobbi C., Biondi-Zoccai G., D'Ascenzo F., Palazzuoli A., Gasperetti A. et al. Acute coronary syndromes and COVID-19: exploring the uncertainties. J. Clin. Med. 2020; 9 (6): 1683. DOI: 10.3390/jcm9061683
- Musher D., Abers M., Corrales-Medina V. Acute infection and myocardial infarction. N. Engl. J. Med. 2019; 380: 171–6. DOI: 10.1056/NEJMra1808137
- Stary H., Chandler A., Dinsmore R., Fuster V., Glagov S., Insull W. et al. A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis: a report from the committee on vascular lesions of the council on arteriosclerosis, American Heart Association. Circulation. 1995; 92: 1355–74. DOI: 10.1161/01.CIR.92.5.1355
- Mauriello A., Sangiorgi G., Fratoni S., Palmieri G., Bonanno E., Anemona L. et al. Diffuse and active inflammation occurs in both vulnerable and stable plaques of the entire coronary tree: a histopathologic study of patients dying of acute myocardial infarction. J. Am. Coll. Cardiol. 2005; 45: 1585–93. DOI: 10.1016/j.jacc.2005.01.054.
- Crea F., Liuzzo G. Pathogenesis of acute coronary syndromes. J. Am. Coll. Cardiol. 2013; 61: 1–11. DOI: 10.1016/j.jacc.2012.07.064 16. Libby P. Mechanisms of acute coronary syndromes and their implications for therapy. N. Engl. J. Med. 2013; 368: 2004–13. DOI: 10.1056/NEJMra1216063 17. Fuster V., Badimon L., Badimon J., Chesebro J., Epstein F. The pathogenesis of coronary artery disease and the acute coronary syndromes. N. Engl. J. Med. 1992; 326: 242–50.
- Liu P., Blet A., Smyth D., Li H. The science underlying COVID-19: implications for the cardiovascular system. Circulation. 2020; 142 (1): 68–78. DOI: 10.1161/CIRCULATIONAHA.120.047549
- Rose J., Voora D., Cyr D., Lucas J., Zaas A., Woods C. et al. Gene expression profiles link respiratory viral infection, platelet response to aspirin, and acute myocardial infarction. PLoS ONE. 2015; 10: e0132259. DOI: 10.1371/journal.pone.0132259
- Clerkin K., Fried J., Raikhelkar J., Sayer G., Griffin J., Masoumi A. et al. Coronavirus disease 2019 (COVID-19) and cardiovascular disease. Circulation. 2020; 141: 1648–55. DOI: 10.1161/CIRCULATIONAHA.120.046941
- Zheng Y., Ma Y., Zhang J., Xie X. COVID-19 and the cardiovascular system. Nat. Rev. Cardiol. 2020; 17: 259–60. DOI: 10.1038/s41569-020-0360-5
- Chieffo A., Stefanini G., Price S., Barbato E., Tarantini G., Karam N. et al. EAPCI position statement on invasive management of acute coronary syndromes during the COVID-19 pandemic. Eur. Heart J. 2020; 41: 1839–51. DOI: 10.1093/eurheartj/ehaa381
- Skulstad H., Cosyns B., Popescu B.A., Galderisi M., Salvo G.D., Donal E. et al. COVID-19 pandemic and cardiac imaging: EACVI recommendations on precautions, indications, prioritization, and protection for patients and healthcare personnel. Eur. Heart J. Cardiovasc. Imaging. 2020; 21: 592–8. DOI: 10.1093/ehjci/jeaa072
- Arentz M., Yim E., Klaff L., Lokhandwala S., Riedo F.X., Chong M. et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington state. JAMA. 2020; 323 (16): 1612–4. DOI: 10.1001/jama.2020.4326
- Sato R., Nasu M. A review of sepsis-induced cardiomyopathy. J. Intensive Care. 2015; 3: 48. DOI: 10.1186/s40560-015-0112-5
- Sala S., Peretto G., Gramegna M., Palmisano A., Villatore A., Vignale D. et al. Acute myocarditis presenting as a reverse tako-tsubo syndrome in a patient with SARS-CoV-2 respiratory infection. Eur. Heart J. 2020; 41 (19): 1861–2. DOI: 10.1093/eurheartj/ehaa286
- Ibanez B., James S., Agewall S., Antunes M.J., Bucciarelli-Ducci C., Bueno H. et al. ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur. Heart J. 2018; 39: 119–77. DOI: 10.1093/eurheartj/ehx393
- Troponin and BNP Use in COVID-19. American College of Cardiology. Available at:https://www. acc.org/latest-in-cardiology/articles/2020/03/18/15/25/troponin-and-bnp-use-in-covid19 (дата обращения 17.05.2022/accessed May 17, 2022).
- Stefanini G., Montorfano M., Trabattoni D., Andreini D., Ferrante G., Ancona M. et al. STelevation myocardial infarction in patients with COVID-19: clinical and angiographic outcomes. Circulation. 2020; 141: 2113–6. DOI: 10.1161/CIRCULATIONAHA.120.047525
- Hendren N., Drazner M., Bozkurt B., Cooper L. Jr. Description and proposed management of the acute COVID-19 cardiovascular syndrome. Circulation. 2020; 141: 1903–14. DOI: 10.1161/CIRCULATIONAHA.120.047349
- Cosyns B., Lochy S., Luchian M.L., Gimelli A., Pontone G., Allard S.D. et al. The role of cardiovascular imaging for myocardial injury in hospitalized COVID-19 patients. Eur. Heart J. Cardiovasc. Imaging. 2020; 21: 709–14. DOI: 10.1093/ehjci/jeaa136
- Jing Z., Zhu H., Yan X., Chai W., Zhang S. Recommendations from the peking union medical college hospital for the management of acute myocardial infarction during the COVID-19 outbreak. Eur. Heart J. 2020; 41: 1791–4. DOI: 10.1093/eurheartj/ehaa258
- Mahmud E., Dauerman H., Welt F., Messenger J., Rao S., Grines C. et al. Management of acute myocardial infarction during the COVID-19 pandemic. J. Am. Coll. Cardiol. 2020; 96: 336–45. S0735-1097(20)35026-9. DOI: 10.1016/j.jacc.2020.04.039
- Collet J., Thiele H., Barbato E., Barthélémy O., Bauersachs J., Bhatt D. et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur. Heart J. 2020: 1–79. DOI: 10.1093/eurheartj/ehaa575
- Valente S., Anselmi F., Cameli M. Acute coronary syndromes during COVID-19. Eur. Heart J. 2020; 41: 2047–49. DOI: 10.1093/eurheartj/ehaa457
- Zeng J., Huang J., Pan L. How to balance acute myocardial infarction and COVID-19: the protocols from Sichuan Provincial People's Hospital. Intensive Care Med. 2020; 46: 1111–3. DOI: 10.1007/s00134-020-05993-9
- Welt F., Shah P., Aronow H., Bortnick A., Henry T., Sherwood M. et al. American College of Cardiology's Interventional Council and the Society for Cardiovascular Angiography and Interventions. Catheterization laboratory considerations during the coronavirus (COVID-19) pandemic: from the ACC's interventional council and SCAI. J. Am. Coll. Cardiol. 2020; 75: 2372–5. DOI: 10.1016/j.jacc.2020.03021
- Wang N., Zhang M., Su H., Huang Z., Lin Y., Zhang M. Fibrinolysis is a reasonable alternative for STEMI care during the COVID-19 pandemic. J. Int. Med. Res. 2020; 48: 300060520966151. DOI: 10.1177/0300060520966151
- Zhang L., Fan Y., Lu Z. Experiences and lesson strategies for cardiology from the COVID-19 outbreak in Wuhan, China, by 'on the scene' cardiologists. Eur. Heart J. 2020; 41: 1788–90. DOI: 10.1093/eurheartj/ehaa266
- Keeley E.C., Boura J.A., Grines C.L. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet. 2003; 361: 13–20. DOI: 10.1016/S0140-6736(03)12113-7
- De Rosa S., Spaccarotella C., Basso C., Calabrò M.P., Curcio A., Filardi P.P. et al. Società Italiana di Cardiologia and the CCU Academy investigators group. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era. Eur. Heart J. 2020; 41: 2083–8. DOI: 10.1093/eurheartj/ehaa610
- Chu C., Cheng V., Hung I., Wong M., Chan K., Chan K. et al. Role of lopinavir/ritonavir in the treatment of SARS: Initial virological and clinical findings. Thorax. 2004 DOI: 10.1136/thorax. 2003.012658
- Kim U., Won E., Kee S., Jung S., Jang H. Combination therapy with lopinavir/ritonavir, ribavirin and interferon – a for Middle East respiratory syndrome. Antivir. Ther. 2016; 21: 455–9. DOI: 10.3851/IMP3002
- Cao B., Wang Y., Wen D., Liu W., Wang J., Fan G. et al. A trial of lopinavir-ritonavir in adults hospitalized with severe covid-19. N. Engl. J. Med. 2020; 382: 1787–99. DOI: 10.1056/NEJMoa2001282
- Duangchaemkarn K., Reisfeld B., Lohitnavy M. A pharmacokinetic model of lopinavir in combination with ritonavir in human; Proceedings of the 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society; Chicago, IL, USA. 2014; 5699–702.
- Driggin E., Madhavan M., Bikdeli B., Chuich T., Laracy J., Bondi-Zoccai G. et al. Cardiovascular considerations for patients, health care workers, and health systems during the coronavirus disease 2019 (COVID-19) pandemic. J. Am. Coll. Cardiol. 2020; 75 (18): 2352–71. DOI: 10.1016/j.jacc.2020.03.031
- The use of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with COVID-19. World Health Organization. Available at: https://www.who.int/news-room/commentaries/detail/the-use-of-non-steroidal-anti-inflammatorydrugs-(nsaids)-in-patients-with-covid-19 (дата обращения 18.05.2020/accessed May 18, 2020).
- Little P. Non-steroidal anti-inflammatory drugs and covid-19. BMJ. 2020; 368: m1185. DOI: 10.1136/bmj.m1185
- Capel R., Herring N., Kalla M., Yavari A., Mirams G., Douglas G. et al. Hydroxychloroquine reduces heart rate by modulating the hyperpolarization-activated current if: novel electrophysiological insights and therapeutic potential. Heart Rhythm. 2015; 12 (10): 2186–94. DOI: 10.1016/j.hrthm.2015.05.027
- Vaduganathan M., Vardeny O., Michel T., McMurray J., Pfeffer M., Solomon S. Renin–angiotensin– aldosterone system inhibitors in patients with COVID-19. N. Engl. J. Med. 2020; 382: 1653–9. DOI: 10.1056/NEJMsr2005760
- Sanders J., Monogue M., Jodlowski T., Cutrell J. Pharmacologic treatments for coronavirus disease 2019 (COVID-19): a review. JAMA. 2020; 323 (18): 1824–36. DOI: 10.1001/jama.2020.6019
- Peterson D., Van Ermen A. Increased warfarin requirements in a patient with chronic hepatitis C infection receiving sofosbuvir and ribavirin. Am. J. Health Pharm. 2017; 74: 888–92. DOI: 10.2146/ajhp160730
- Puglisi G., Smith S., Jankovich R., Ashby C., Jodlowski T. Paritaprevir/ritonavir/ombitasvir + dasabuvir plus ribavirin therapy and inhibition of the anticoagulant effect of warfarin: a case report. J. Clin. Pharmacol. 2017; 42: 115–8. DOI: 10.1111/jcpt.12475
- Tang N., Bai H., Chen X., Gong J., Li D., Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J. Thromb. Haemost. 2020; 18 (5): 1094–9. DOI: 10.1111/jth.14817
- Metzler B., Siostrzonek P., Binder R.K., Bauer A., Reinstadler S.J. Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage. Eur. Heart J. 2020; 41: 1852–3. DOI: 10.1093/eurheartj/ehaa314
- Huet F., Prieur C., Schurtz G., Gerbaud E., Manzo-Silberman S., Vanzetto G. et al. One train may hide another: acute cardiovascular diseases could be neglected because of the COVID-19 pandemic. Arch. Cardiovasc. Dis. 2020; 113: 303–7. DOI: 10.1016/j.acvd.2020.04.002
- Garcia S., Albaghdadi M., Meraj P., Schmidt C., Garberich R., Jaffer F. et al. Reduction in ST-segment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic. J. Am. Coll. Cardiol. 2020; 75: 2871–2. DOI: 10.1016/j.jacc.2020.04.011
- Rodriguez-Leor O., Cid-Alvarez B. ST-segment elevation myocardial infarction care during COVID-19: losing sight of the forest for the trees. JACC Case Rep. 2020; 2: 1625–7. DOI: 10.1016/j.jaccas.2020.04.011
- Quadri G., Rognoni A., Cerrato E., Baralis G., Boccuzzi G., Brsic E. et al. Catheterization laboratory activity before and during COVID-19 spread: a comparative analysis in Piedmont, Italy, by the Italian Society of Interventional Cardiology (GISE). Int. J. Cardiol. 2020; 323: 288–91. DOI: 10.1016/j.ijcard.2020.08.072
- Yousefzai R., Bhimaraj A. Misdiagnosis in the COVID-19 Era: when zebras are everywhere, don't forget the horses. JACC Case Rep. 2020; 2: 1614–9. DOI: 10.1016/j.jaccas.2020.04.018
- Scott I.A. “Time is muscle” in reperfusing occluded coronary arteries in acute myocardial infarction. Med. J. Aust. 2010; 193: 493–5. DOI: 10.5694/j.1326-5377.2010.tb04030.x
- Trabattoni D., Montorsi P., Merlino L. Late STEMI and NSTEMI patients' emergency calling in COVID-19 outbreak. Can. J. Cardiol. 2020; 36: 1161.e7–8. DOI: 10.1016/j.cjca.2020.05.003
- Tam C., Cheung K., Lam S., Wong A., Yung A., Sze M. et al. Impact of coronavirus disease 2019 (COVID-19) outbreak on outcome of myocardial infarction in Hong Kong, China. Catheter Cardiovasc Interv. 2020; 13: e006631. DOI: 10.1002/ccd28943
- Boukhris M., Hillani A., Moroni F., Annabi M.S., Addad F., Ribeiro M.H. et al. Cardiovascular implications of the COVID-19 pandemic: a global perspective. Can. J. Cardiol. 2020; 36: 1068–80. DOI: 10.1016/j.cjca.2020.05.018
- Baldi E., Sechi G.M., Mare C., Canevari F., Brancaglione A., Primi R. et al. Lombardia CARe researchers. Out-of-hospital cardiac arrest during the Covid-19 outbreak in Italy. N. Engl. J. Med. 2020; 383: 496–8. DOI: 10.1056/NEJMc2010418
- Mountantonakis S., Saleh M., Coleman K., Kuvin J., Singh V., Jauhar R. et al. Out-of-hospital cardiac arrest and acute coronary syndrome hospitalizations during the COVID-19 surge. J. Am Coll. Cardiol. 2020; 76: 1271–3. DOI: 10.1016/j.jacc.2020.07.021
- Baigent C., Windecker S., Andreini D., Arbelo E., Barbato E., Bartorelli A.L. et al. Task force for the management of COVID-19 of the European Society of Cardiology, European Society of Cardiology guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 1-epidemiology, pathophysiology, and diagnosis. Cardiovasc. Res. 2022; 118 (6): 1385–412. DOI: 10.1093/cvr/cvab342
- Order of the Ministry of Health of the Moscow Region No. 50-R dated 04/29/2020 “On routing patients to provide specialized, including hightech, medical care with acute coronary syndrome in inpatient conditions without suspicion and with confirmed covid-19 disease”. Available at: https://mz.mosreg.ru/dokumenty/normotvorchestvo/rasporyaditelnye-dokumenty-ministerstva/06-05- 2020-18-06-45-rasporyazhenie-ministerstvazdravookhraneniya-mosk (accessed May 04, 2022) (in Russ.).
About Authors
- Igor’ I. Serebrennikov, Postgraduate; ORCID
- Filipp Yu. Kopylov, Dr. Med. Sci., Professor; ORCID
- Roman N. Komarov, Dr. Med. Sci., Chief of Chair; ORCID
- Maruar B. Mukanova, Postgraduate; ORCID
- Alisher M. Ismailbaev, Cand. Med. Sci., Associate Professor; ORCID
- Sergey V. Markitan, Chief Physician; ORCID
- Furkatdzhon S. Gafurov, Cand. Med. Sci., Head of Department; ORCID