Problems of care for STEMI patients in coronavirus pandemic

Å imek, S.

The covid-19 pandemic negatively affects time-dependent care and the course of STEMI in several aspects: ? Some patients delay seeking emergency care or even do not call it at all because of fear of contracting covid-19 at hospitals. ? The presentations of STEMI and covid-19 can overlap and mimic each other. Both conditions may coexist. Uncertainty regarding diagnosis may add to delays. ? Provider?s concerns about the covid-19 infection or lack of cath lab staff may lead to changes in treatment algorhithms. ? There may also be delay due to the infection-control measures employed by medical staff. ? Reduction in non-covid care, overwhelmed emergency medical services and hospitals, staff-absences, and lack of beds may all lead to treatment delay or even inability to provide it. ? Inflammatory and prothrombotic states in patients with covid-19 increase the risk of developing STEMI as well as that of STEMI complications. ? Hypoxia due to covid-19 lung disease deepens myocardial ischemia during STEMI and may extend the volume of STEMI and increase the risk of heart failure. ? Covid myocarditis. Conclusion: It is apparent that STEMI in covid-19 infected patients is not the same disease process as STEMI that without covid-19 infection. Patients with STEMI and covid-19 have a higher risk of heart failure, cardiac arrest, cardiogenic shock, greater intracoronary thrombosis and stent thrombosis, resulting in higher cardiac and non-cardiac mortality. Aggressive antithrombotic treatment is recommended. Even in the covid era it is essential to insist on timely treatment of STEMI. Training of cardiac catheterization personnel on how to use personal protective equipment as well as vaccination are crucial to limit the risk of acquiring infection.