Abstract

JACC

Lots of interesting abstracts and cases were submitted for TCTAP 2022. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!

TCTAP A-006

Characteristics and Outcomes in Patients Presenting With COVID-19 and ST-Segment Elevation Myocardial Infarction

By David Baghdasaryan

Presenter

David Baghdasaryan

Authors

David Baghdasaryan1

Affiliation

Nork-Marash Medical Center, Armenia1
View Study Report
TCTAP A-006
Acute Coronary Syndromes (STEMI, NSTE-ACS)

Characteristics and Outcomes in Patients Presenting With COVID-19 and ST-Segment Elevation Myocardial Infarction

David Baghdasaryan1

Nork-Marash Medical Center, Armenia1

Background

COVID-19 was declared a pandemic by the World Health Organization on 11 March 2020. A worse prognosis and a more severe progression of COVID-19 have been associated with cardiovascular risk factors, previous cardiac diseases and myocardial injury.

Methods

Cardiovascular manifestations in the COVID-19 patient are complex: patients may present with 
AMIMyocarditis simulating a STEMI presentationStress cardiomyopathyNon-ischemic cardiomyopathyCoronary spasm, or Myocardial injury without a documented Type I or             Type II AMI  

Results

•Surprisingly, and in contrast to these theoretical expectations, recent data suggest that the admission rate for ACS during the COVID-19 pandemic is much lower than expected rather than higher.

In Austria, hospital admissions for ACS decreased by 39% in the last calendar week in March 2020 as compared with the first week, mainly affecting patients with non-ST-segment elevation myocardial infarction (NSTEMI).9 Similarly, in Italy, a survey of the Italian Society of Cardiology (SIC) comparing a 1-week period during the COVID-19 outbreak vs. the equivalent week in 2019 showed a 48%reduction in admissions for acute MI (26% for STEMI and 65% for NSTEMI.

Conclusion

•Timelyreperfusion of the affected myocardial tissue is fundamental in the management of patients with STEMI  
•Rapidtreatment for STEMI with standart antithrombotic care                       (Heparin       Canglerol       Ticaglerol)
•Toavoid the possible cross-infection, a conservative strategy was principally preferred, but an invasive strategy sometimes became mandatory. Thus, the benefit/risk ratio of either approach should be weighed carefully. For a STEMIpatient with low bleeding risk, shorter ischemic time, relative less or less important myocardium (e.g., inferior wall) involved, the fibrinolytic therapy with third generation of fibrinolytic agent may be preferred. On the contrary, for elderly, patients with massive myocardium in jeopardy, longer ischemic time, or not satisfactorily reperfusion conservatively, resulting in recurrent ischemic events and/or electric/hemodynamic instability, the invasive strategy is strongly indicated.
•Arecent publication by Zhang et al.[15] describe the presence of antiphospholipid antibodies in COVID-19 patients, which may lead to thrombotic events. In this regard, the necessity of antiplatelet therapy or intensifying an established therapy in COVID-19 patients with pre-existing coronary heart disease or a history of stenting, especially recent stenting, remains the goal of further research 15.
•Elevatedbiomarkers of thrombosis, such as D-dimer, IL-6, CRP, TnT are associated with disease progression and higher mortality 16
Consider a LMWH or UHpreferentially as the initial agent in the hospital, and transition to DOACsafter critical phase is over, and certainly at discharge.

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