TY - JOUR
T1 - Management of acute coronary syndromes during the COVID-19 outbreak in Lombardy
T2 - The “macro-hub” experience
AU - Carugo, Stefano
AU - Ferlini, Marco
AU - Castini, Diego
AU - Andreassi, Aida
AU - Guagliumi, Giulio
AU - Metra, Marco
AU - Lombardi, Carlo
AU - Cuccia, Claudio
AU - Savonitto, Stefano
AU - Piatti, Luigi
AU - D'Urbano, Maurizio
AU - Lettieri, Corrado
AU - Vandoni, Pietro
AU - Lettino, Maddalena
AU - Marenzi, Giancarlo
AU - Montorfano, Matteo
AU - Zangrillo, Alberto
AU - Castiglioni, Battistina
AU - De Ponti, Roberto
AU - Oltrona Visconti, Luigi
N1 - Publisher Copyright:
© 2020 The Author(s)
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/12
Y1 - 2020/12
N2 - 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.
AB - 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.
KW - Acute coronary syndromes
KW - COVID-19
KW - Macro-hubs
KW - NSTEMI
KW - Sars-CoV2
KW - STEMI
UR - http://www.scopus.com/inward/record.url?scp=85097394207&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85097394207&partnerID=8YFLogxK
U2 - 10.1016/j.ijcha.2020.100662
DO - 10.1016/j.ijcha.2020.100662
M3 - Article
AN - SCOPUS:85097394207
VL - 31
JO - IJC Heart and Vasculature
JF - IJC Heart and Vasculature
SN - 2352-9067
M1 - 100662
ER -