key: cord-1051005-fxqyd8e8
authors: Case, Brian C.
title: COVID-19 pandemic and acute myocardial infarction: Don't ignore chest pain
date: 2022-02-18
journal: Cardiovasc Revasc Med
DOI: 10.1016/j.carrev.2022.02.012
sha: 0a71500eca0d542020cb5e9150fd0e2877710b18
doc_id: 1051005
cord_uid: fxqyd8e8

nan

The coronavirus disease 2019 (COVID-19) pandemic has resulted in a substantial increase in mortality arising from acute respiratory distress syndrome and fatal complications, which has brought immediate, direct, and unprecedented global changes to our world and healthcare system (1) . In addition to the immediate threat posed by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, resulting in morbidity and mortality in millions of infected patients globally, changes in human behavior and resource allocations have led to a detrimental impact on public health (2) .

Specifically, the regulations and measures taken to reduce viral transmission, such as public lockdowns, resulted in non-COVID-19-care becoming severely undermined. The COVID-19 pandemic has necessitated an unprecedented reorganization and rapid reshuffling of emergency care facilities worldwide to accommodate the increased clinical workload.

Further healthcare avoidance and treatment delays are apparent(3) and are of important concern for medically emergent conditions such as acute myocardial infarction (AMI). People with acute and chronic diseases have been reluctant to seek medical help, fearing that visits to emergency rooms and medical institutes could expose them to SARS-CoV-2. Worldwide, this observation has been reported, with reduction in AMI admissions and significant decreases in the number of cardiac procedures, including primary percutaneous coronary intervention, with worsened in-hospital outcomes (4) . In this issue of Cardiovascular Revascularization Medicine, Lavie and colleagues (5) The finding of lower incidence of AMI hospitalization during the early COVID-19 lockdown is in line with other reports (6, 7) . This finding is due, in part, to healthcare avoidance prompted by the fear of contracting SARS-CoV-2 infection in these centers and patients reluctant to seek care unless their symptoms were very severe. This led to patients arriving with a more severe presentation (i.e., mechanical complications due to AMI) or worse outcomes (8) . Increases in out-of-hospital cardiac arrest have been reported in some countries (9, 10) . Unfortunately, the authors did not provide data on out-ofhospital death, and therefore, it is difficult to conclude whether there was any detrimental effect of "medical distancing" in the authors' study population.

Furthermore, it is important to highlight that early on in the pandemic (study time period), even after AMI patients presented to the emergency room, delays to receiving potential primary J o u r n a l P r e -p r o o f percutaneous coronary intervention were unavoidable. Stringent screening for COVID-19 was the primary focus of avoiding the nosocomial spread of COVID-19 rather than maintaining proper management of AMI. These factors collectively led to longer time delays in the diagnosis and treatment of AMI patients. However, over time, hospital policies and protocols were implemented to ensure that all participating staff wear personal protective equipment to allow immediate primary percutaneous coronary intervention where appropriate.

Ongoing evidence has shown that the current pandemic is causing excessive deaths, both COVID-19 and non-COVID-19 (11) . The authors did not show any increase in 30-day mortality of AMI patients during the pandemic in Israel. Although 30 days is a relatively short period and the full effect of COVID-19 on AMI may yet to be fully unveiled, the data are reassuring. In addition, it is important to recognize that the combination of COVID-19 and AMI continues to carry higher morbidity and mortality (12) . However, over time, this rate has improved with the improvement of treatment options for COVID-19, early recognition of the disease process, and ongoing emphasis on early coronary angiography and percutaneous coronary intervention when appropriate (13) .

The COVID-19 pandemic continues to present an unprecedented challenge and is changing the world and healthcare system. AMI admissions are reduced but care quality maintained, which has

Covid-19 -Navigating the Uncharted

Assessing the indirect effects of COVID-19 on healthcare delivery, utilization and health outcomes: a scoping review

International Prospective Registry of Acute Coronary Syndromes in Patients With COVID-19

COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England

Change in hospitalizations and 30-day mortality of patients with acute myocardial infarction during the first COVID-19 lockdown -A pure social isolation effect?

Impact of COVID-19 Pandemic on Mechanical Reperfusion for Patients With STEMI

The Covid-19 Pandemic and the Incidence of Acute Myocardial Infarction

Six-Month Outcomes for COVID-19 Negative Patients with Acute Myocardial Infarction Before Versus During the COVID-19 Pandemic

Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy

Characteristics Associated With Out-of-Hospital Cardiac Arrests and Resuscitations During the Novel Coronavirus Disease

Excess Deaths From COVID-19 and Other Causes

Comparison of Characteristics and Outcomes of Patients With Acute Myocardial Infarction With Versus Without Coronarvirus-19

Evolution of Management and Outcomes of Patients with Myocardial Injury During the COVID-19 Pandemic