Elsevier

IJC Heart & Vasculature

Volume 31, December 2020, 100662
IJC Heart & Vasculature

Management of acute coronary syndromes during the COVID-19 outbreak in Lombardy: The “macro-hub” experience

https://doi.org/10.1016/j.ijcha.2020.100662Get rights and content
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Abstract

Background

During the COVID-19 outbreak, healthcare Authorities of Lombardy modified the regional network concerning time-dependent emergencies. Specifically, 13 Macro-Hubs were identified to deliver timely optimal care to patients with acute coronary syndromes (ACS). Aim of this paper is to present the results of this experience.

Methods and Results

This is a multicenter, observational study. A total of 953 patients were included, presenting with STEMI in 57.7% of the cases. About 98% of patients received coronary angiography with a median since first medical contact to angiography of 79 (IQR 45–124) minutes for STEMI and 1262 (IQR 643–2481) minutes for NSTEMI.

A total of 107 patients (11.2%) had SARS-CoV2 infection, mostly with STEMI (74.8%). The time interval from first medical contact to cath-lab was significant shorter in patients with COVID-19, both in the overall population and in STEMI patients (87 (IQR 41–310) versus 160 (IQR 67–1220) minutes, P = 0.001, and 61 (IQR 23–98) versus 80 (IQR 47–126) minutes, P = 0.01, respectively). In-hospital mortality and cardiogenic shock rates were higher among patients with COVID-19 compared to patients without (32% vs 6%, P < 0.0001, and 16.8% vs 6.7%, P < 0.0003, respectively).

Conclusions

During the COVID-19 outbreak in Lombardy, the redefinition of ACS network according to enlarged Macro-Hubs allowed to continue with timely ACS management, while reserving a high number of intensive care beds for the pandemic. Patients with ACS and COVID-19 presented a worst outcome, particularly in case of STEMI.

Keywords

COVID-19
Sars-CoV2
Acute coronary syndromes
STEMI
NSTEMI
Macro-hubs

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All authors take responsibility for all the aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.