CCCardiol CroatCardiologia CroaticaCardiol. Croat.1848-543X1848-5448Croatian Cardiac SocietyCC 2020 15_7-8_212-310.15836/ccar2020.212ResponseRe: Primary PCI procedures during the COVID-19 pandemic: Global ExperienceOdgovor: Postupak primarne perkutane koronarne intervencije tijekom pandemije COVID-19: globalno iskustvohttps://orcid.org/0000-0002-7060-8375BabićZdravko*https://orcid.org/0000-0001-9224-363XMargetićEduardhttps://orcid.org/0000-0001-9101-1570MiličićDavorRadna skupina za akutni koronarni sindrom i Radna skupina za intervencijsku kardiologiju, Hrvatsko kardiološko društvo, HrvatskaWorking Group on Acute Coronary Syndrome & Working Group on Invasive and Interventional Cardiology, Croatian Cardiac Society, CroatiaAddress for correspondence: Zdravko Babić, Klinički bolnički centar Sestre milosrdnice, Vinogradska 29, HR-10000 Zagreb, Croatia. / Phone: +385-1-3787-965 / E-mail: zbabic@net.hr062020157-821221319052020200520202020Croatian Cardiac Society
The authors would like to thank their colleagues from Iraq for their reaction to article published in the Cardiologia Croatica journal (1). A trend of significant reduction in the number of patients with acute myocardial infarction (AMI) who are admitted and hospitalized during the COVID-19 pandemic is being reported across Europe and the United States. The STENOS registry of percutaneous coronary interventions shows similar results for ST-elevated myocardial infarction in most centres in the Republic of Croatia (Figure 1). Most foreign authors explain this condition as primarily due to fear, even in critically ill patients, of arriving at hospitals during the COVID-19 pandemic and risking infection, and to a lesser extend as resulting from the reduced availability of emergency medical services as well as substituting AMI symptoms for COVID-19 infection. Consequences of quarantine and self-isolation such as less exposure to psychological stressors, less air pollution, better adherence to drug therapy, lower blood pressure, less smoking because of fear of COVID-19 respiratory infection, more rest, and less exertion are some of the additional mechanisms which the cardiac community considered as potentially reducing the incidence AMI during this pandemic. However, during the COVID-19 pandemic, a higher incidence of some otherwise less common AMI complications such as mechanical complications (e.g., myocardial rupture) or cardiogenic shock (2) has been reported. Furthermore, the decrease in the number of patients with acute coronary syndrome treated in Austrian hospitals in March this year, lead the Austrian authors (3) to estimate that the number of deaths in these patients could be higher than that of COVID-19 infection at the same time. We therefore agree with colleagues from Iraq that it is time for health professionals, even in public, to point out this problem and the danger of avoiding emergency treatment for conditions such as AMI.
The number of patients with acute ST-elevation myocardial infarction treated with primary percutaneous coronary intervention – data from the Croatian STENOS PCI Registry.
LITERATUREBabićZMargetićEMiličićD. Primary Percutaneous Coronary Intervention during the COVID-19 Pandemic. . 2020;15(5-6):91–6. 10.15836/ccar2020.91TCTMD. The Mystery of the Missing STEMIs During the COVID-19 Pandemic. Available from: https://www.tctmd.com/news/mystery-missing-stemis-during-covid-19-pandemic (May 19, 2020).MetzlerBSiostrzonekPBinderRKBauerAReinstadlerSJ. Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage. . 2020 May 14;41(19):1852–3. 10.1093/eurheartj/ehaa31432297932