For Correspondence
Comentale Giuseppe, MD
giuseppe.comentale@unina.it,Division of Cardiac Surgery
”Federico II” University - Via Sergio Pansini n°5, 80131 - Napoli
(Italy)
Main Body
Back to the past? The incidence of mechanical complications of acute
coronary syndromes (ACS) needing cardiac surgery has reduced
significantly in the last years due to early diagnosis and treatments.
Primary coronary angioplasty of culprit lesions, indeed, allowed rescue
of vital myocardium after ACS with significant impact on the functional
recovery of the heart and long-term morbidity.
COVID-19 pandemic may oddly lead to a changing scenario and
significantly modify the cardiac surgery population that we will be
dealing with in the next weeks. The widespread demand for intensive and
sub-intensive care beds, as well as a cardiac tropism of SARS-COV-2
[1], has brought to an extensive reassessment of hospitals and
emergency rooms (ERs) into COVID-dedicated structures, making them
potential contagion areas. In Italy, for example, more than 10% of
COVID-patients are healthcare providers showing how a severe protection
policy among hospitals staff is mandatory to protect not only themselves
but all kinds of patients. In support of this, “Cotugno”
Infectivological Hospital of Napoli, through the highest
protection/decontamination protocols, is the only Italian hospital
without healthcare SARS-COV-2 infections.
This phenomenon, therefore, would generate in the patients a sense of
fear regarding access to the ERs: the patient with an ACS, indeed,
especially diabetic ones, probably ends up underestimating symptoms such
as chest pain or angina equivalents and not going to the ER quickly,
relying on home remedies. This behaviour, contrary to what would be
expected given the current predilection of an endovascular treatment of
ACSs aimed at minimizing the impact on intensive care [2], could
frustrate the prevention strategies based on the earliness of
intervention implemented in these years and thus creating a vast pool of
patients who will enter the hospital in more critical situations and
with mechanical complications of an evolving ACS. Papillary muscles
ruptures and acute mitral regurgitations, ruptures of the
interventricular septum or of the walls of the heart, in fact, together
with the aneurysmal dilations of untreated necrotic areas could became
an important part of the cardiac surgery population in the next weeks.
For this purpose, strategies concerning people education and a
centralization of cardiovascular care towards “protected” structures
could restore the patient’s confidence in going to the ERs at an early
stage of symptoms and stem a phenomenon that could trigger an important
increase in cardiovascular morbidity and mortality.
References
- Fried
JA et al. The Variety of Cardiovascular Presentations of COVID-19.
Circulation. 2020
Apr 3.
- Tarantini
G et al. Italian Society of Interventional Cardiology (GISE) Position
Paper for Cath lab-specific Preparedness Recommendations for
Healthcare providers in case of suspected, probable or confirmed cases
of COVID-19.
Catheter
Cardiovasc Interv. 2020 Mar 29.