scholarly journals The changes in therapeutic and managerial protocols for patients suffering ST-segment elevation myocardial infarction in COVID-19 pandemic; a systematic review and meta-analysis

2020 ◽  
Vol 5 (2) ◽  
pp. e25-e25
Author(s):  
Hosna Mirfakhraee ◽  
Maryam Niksolat ◽  
Samaneh Saghafian Larijani ◽  
Zhale Zandieh
Keyword(s):  
Myocardial Infarction ◽  
Heart Disease ◽  
Thrombolytic Therapy ◽  
Ischemic Heart Disease ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Ischemic Heart ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Introduction: Apart from the direct effect of COVID-19 on the incidence of ischemic heart disease, the pandemic effect of this infection on the control of ischemic heart disease and on the clinical consequences of these patients and also their hospital admission is also significant. Objectives: The present review attempted to assess the admission rate, treatment protocols, and outcome changes in patients suffering ST-segment elevation myocardial infarction (STEMI) in the COVID-19 outbreak. Materials and Methods: The included studies were identified through electronically reviewing the manuscripts databases of MEDLINE, EMBASE, Web of knowledge, and Google Scholar from inception to September 2020. The titles and abstracts of the manuscripts were screened by two blinded reviewers followed by an in-depth assessment of the full texts for assigning the inclusion appropriateness. Results: Eighteen articles (including 6225 STEMI patients hospitalized within the COVID-19 pandemic duration and 55711 STEMI patients in pre-COVID-19 periods) were desirable for the final analysis. A longer delay among symptom onset and first medical contact (FMC) in the COVID-19 lockdown period than before the COVID-19 pandemic was revealed. Comparing STEMI-related death in the COVID-19 period compared to the pre-COVID-19 duration showed a significantly higher death rate and a higher rate of thrombolytic therapy. The examined pre-COVID-19 and COVID-19 periods showed a reduction in STEMI patients’ admissions reached 30.9%. Additionally, entering the COVID-19 period resulted in a significant 44.4% reduction in the number of primary percutaneous coronary intervention. Conclusion: During the COVID-19 pandemic, the management of STEMI has undergone significant changes, including reduced hospital admissions, reduced invasive and semi-invasive treatment interventions, increased STEMI-related mortality, increased thrombolytic therapy, and delayed patients’ referral to the hospitals.

scholarly journals The Role of Ticagrelor in STEMI Fibrinolytic and Its Rationale to Utilize for Indonesian Patients

2019 ◽  
Vol 40 (4) ◽  
Author(s):  
Daniel Tobing ◽  
Dafsah Juzar ◽  
Achmad Fauzi Yahya ◽  
Antonia Anna Lukito ◽  
Doni Firman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Platelet Inhibition ◽  
Fibrinolytic Therapy ◽  
Ischemic Heart ◽  
Primary Pci ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Worldwide, ischemic heart disease is the most common cause of death and its frequency is increasing. ST-segment elevation myocardial infarction or STEMIis as form of ischemic heart disease with the highest mortality rate. Based on ESC (European Society of Cardiology) guideline 2017 for STEMI management, reperfusion therapywhich is primary PCI strategy is recommended over fibrinolysis within induced timeframes, but if timely primary PCI cannot be performed after STEMI diagnosis, fibrinolytic therapy is recommended within 12 hours of symptom onset in patients without contraindications. In fibrinolytic therapy, oral aspirin should be given, and Clopidogrel is indicated as an addition to aspirin. Although Clopidogrel is a recommended P2Y12receptor inhibitorin fibrinolytic therapy,PERKI guideline 2018 in ACS management also mention thatswitching to Ticagrelor can be considered in patients whowillundergo PCI treatmentafter fibrinolytic. In PLATO study, patients who have acute coronary syndrome with or without ST-segment elevation, treatment with ticagrelor as compared with clopidogrel significantly reduced the rate of death from vascular causes, myocardial infarction, or stroke. However, patients who received fibrinolytic therapy within 24 hours before randomization were excluded. WhileinSET-FAST study, Ticagrelor provides more prompt and potent platelet inhibition compared with Clopidogrel in patients undergoing PCI within 24 hours of receiving fibrinolysis for STEMI. TREAT study was conducted to evaluate the safety of ticagrelor in STEMI patients receiving fibrinolytic therapy within 24 hours.TREAT study concluded, at 30 days observation, in patients younger than 75 years with STEMI, delayed administration of Ticagrelor after fibrinolytic therapy was noninferior to Clopidogrel for TIMI major bleeding. Based on the result from PLATO study and preliminary TREAT study result on 30 days, the use of Ticagrelor within 24 hours after fibrinolytic therapy can be considered with comparable safety profile to Clopidogrel.   Keywords: STEMI, fibrinolysis, ticagrelor

scholarly journals Temporal trends in the presentation of cardiovascular and cerebrovascular emergencies during the COVID-19 pandemic in Germany: an analysis of health insurance claims

2020 ◽  
Vol 109 (12) ◽  
pp. 1540-1548 ◽  
Author(s):  
Moritz Seiffert ◽  
Fabian J. Brunner ◽  
Marko Remmel ◽  
Götz Thomalla ◽  
Ursula Marschall ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Health Insurance ◽  
Hospital Admissions ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
St Segment Elevation ◽  
Admission Rates ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Health Insurance Claims

Abstract Aims The first reports of declining hospital admissions for major cardiovascular emergencies during the COVID-19 pandemic attracted public attention. However, systematic evidence on this subject is sparse. We aimed to investigate the rate of emergent hospital admissions, subsequent invasive treatments and comorbidities during the COVID-19 pandemic in Germany. Methods and results This was a retrospective analysis of health insurance claims data from the second largest insurance fund in Germany, BARMER. Patients hospitalized for acute myocardial infarction, acute limb ischemia, aortic rupture, stroke or transient ischemic attack (TIA) between January 1, 2019, and May 31, 2020, were included. Admission rates per 100,000 insured, invasive treatments and comorbidities were compared from January–May 2019 (pre-COVID) to January–May 2020 (COVID). A total of 115,720 hospitalizations were included in the current analysis (51.3% females, mean age 72.9 years). Monthly admission rates declined from 78.6/100,000 insured (pre-COVID) to 70.6/100,000 (COVID). The lowest admission rate was observed in April 2020 (61.6/100,000). Administration rates for ST-segment elevation myocardial infarction (7.3–6.6), non-ST-segment elevation myocardial infarction (16.8–14.6), acute limb ischemia (5.1–4.6), stroke (35.0–32.5) and TIA (13.7–11.9) decreased from pre-COVID to COVID. Baseline comorbidities and the percentage of these patients treated with interventional or open-surgical procedures remained similar over time across all entities. In-hospital mortality in hospitalizations for stroke increased from pre-COVID to COVID (8.5–9.8%). Conclusions Admission rates for cardiovascular and cerebrovascular emergencies declined during the pandemic in Germany, while patients’ comorbidities and treatment allocations remained unchanged. Further investigation is warranted to identify underlying reasons and potential implications on patients’ outcomes. Graphic abstract

scholarly journals Clinical profile and mortality of ST-Segment elevation myocardial- infarction patients receiving thrombolytic -Therapy in the Middle East

Heart Views ◽  
2012 ◽  
Vol 13 (2) ◽  
pp. 35 ◽  
Author(s):  
Prashanth Panduranga ◽  
Ibrahim Al-Zakwani ◽  
Kadhim Sulaiman ◽  
Alawi Alsheikh-Ali ◽  
Wael Almahmeed ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Middle East ◽  
Thrombolytic Therapy ◽  
Clinical Profile ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment
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