The Society for Cardiovascular Angiography and Interventions (SCAI) has written an open letter to members detailing options for managing patients in the cath lab who present with COVID-19.
SCAI president Ehtisham Mahmud, (University of California, San Diego) points out: “A proportion of patients with COVID-19 develop sequelae of cardiovascular disease including acute coronary syndromes and myocarditis. Optimal treatment options depend on local prevalence of the disease, and the resources and expertise available.”
The document aims to “leverage the lessons from China and determine how we might want to apply them to our healthcare systems”, although Mahmud acknowledges the “paucity of adequate data to guide our next steps, especially as they relate to the care of cardiovascular patients and those who require management in the catheterisation laboratory (cath lab)”.
The letter outlines what to do in three scenarios: cases of confirmed COVID-19, possible positive cases of COVID-19, and elective cath lab patients.
In those confirmed to have COVID-19, Mahmud advises “appropriate infectious disease protection for the entire cath lab team” when treating patients with ST segment myocardial infarction (STEMI) or non-STEMI (NSTEMI) who have ongoing ischaemic symptoms/haemodynamic compromise. Post-transfer patients who have received fibrinolysis should still be taken for rescue percutaneous coronary intervention (PCI) if clinically appropriate. And in NSTEMI patients who are otherwise stable, he suggests that “to minimise the risk of staff exposure, medical management with coronary angiography for recalcitrant symptoms only may be the most logical approach. Elective coronary angiography can then be pursued at a future time when the patient is less infectious.”
Suspected patients who present with a STEMI should be treated with primary PCI and appropriate infectious disease protection. NSTEMI patients should await coronary angiography until a negative COVID-19 test has been obtained.
And for patients aged >65 years who require elective procedures, Mahmud says that delay “seems the most prudent approach” “until we have better assessment of the situation over the next few weeks”. He recommends: “The only patients who should be treated are those with accelerating symptoms or those felt to be too unstable for deferral.”
SACI and the American College of Cardiology (ACC) Interventional Scientific Council are issuing a joint statement that will be published in the Journal of the American College of Cardiology regarding the management of COVID-19 patients who need cath lab services.
Cardiovascular News will update this story as it develops.