EAPCI position statement on invasive management of acute coronary syndromes during the COVID-19 pandemic

A. Chieffo, G.G. Stefanini, S. Price, E. Barbato, G. Tarantini, N. Karam, R. Moreno, G.L. Buchanan, M. Gilard, S. Halvorsen, K. Huber, S. James, F.-J. Neumann, H. Möllmann, M. Roffi, G. Tavazzi, J.M. Ferré, S. Windecker, D. Dudek, A. Baumbach

Research output: Contribution to journalArticlepeer-review


The coronavirus disease 2019 (COVID-19) pandemic poses an unprecedented challenge to healthcare worldwide. The infection can be life threatening and require intensive care treatment. The transmission of the disease poses a risk to both patients and healthcare workers. The number of patients requiring hospital admission and intensive care may overwhelm health systems and negatively affect standard care for patients presenting with conditions needing emergency interventions. This position statements aims to assist cardiologists in the invasive management of acute coronary syndrome (ACS) patients in the context of the COVID-19 pandemic. To that end, we assembled a panel of interventional cardiologists and acute cardiac care specialists appointed by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and from the Acute Cardiovascular Care Association (ACVC) and included the experience from the first and worst affected areas in Europe. Modified diagnostic and treatment algorithms are proposed to adapt evidence-based protocols for this unprecedented challenge. Various clinical scenarios, as well as management algorithms for patients with a diagnosed or suspected COVID-19 infection, presenting with ST- and non-ST-segment elevation ACS are described. In addition, we address the need for re-organization of ACS networks, with redistribution of hub and spoke hospitals, as well as for in-hospital reorganization of emergency rooms and cardiac units, with examples coming from multiple European countries. Furthermore, we provide a guidance to reorganization of catheterization laboratories and, importantly, measures for protection of healthcare providers involved with invasive procedures. © European Society of Cardiology 2020. All rights reserved.
Original languageEnglish
Pages (from-to)233-246
Number of pages14
Issue number3
Publication statusPublished - 2020


  • ACS
  • COVID-19
  • PCI
  • amino terminal pro brain natriuretic peptide
  • brain natriuretic peptide
  • fibrinolytic agent
  • troponin
  • acute coronary syndrome
  • adult respiratory distress syndrome
  • Article
  • assisted circulation
  • cardiogenic shock
  • cardiologist
  • clinical pathway
  • clinical protocol
  • consensus development
  • conservative treatment
  • coronary angiography
  • coronavirus disease 2019
  • emergency ward
  • evidence based medicine
  • health care personnel
  • heart catheterization
  • heart center
  • heart muscle injury
  • high risk patient
  • human
  • intensive care unit
  • intermediate risk patient
  • intermethod comparison
  • low risk patient
  • medical society
  • medical specialist
  • non st segment elevation acute coronary syndrome
  • occupational safety
  • pandemic
  • percutaneous coronary intervention
  • practice guideline
  • prognosis
  • protection
  • protein analysis
  • ST segment elevation acute coronary syndrome
  • ST segment elevation myocardial infarction
  • veno-arterial ECMO
  • veno-venous ECMO
  • algorithm
  • Betacoronavirus
  • cardiology
  • Coronavirus infection
  • Europe
  • virus pneumonia
  • Acute Coronary Syndrome
  • Algorithms
  • Cardiology
  • Coronavirus Infections
  • Humans
  • Pandemics
  • Pneumonia, Viral


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