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

Stefano Carugo, Marco Ferlini, Diego Castini, Aida Andreassi, Giulio Guagliumi, Marco Metra, Carlo Lombardi, Claudio Cuccia, Stefano Savonitto, Luigi Piatti, Maurizio D'Urbano, Corrado Lettieri, Pietro Vandoni, Maddalena Lettino, Giancarlo Marenzi, Matteo Montorfano, Alberto Zangrillo, Battistina Castiglioni, Roberto De Ponti, Luigi Oltrona Visconti

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Article number100662
JournalIJC Heart and Vasculature
Publication statusPublished - Dec 2020


  • Acute coronary syndromes
  • COVID-19
  • Macro-hubs
  • Sars-CoV2

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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