# ST-Segment Elevation Myocardial Infarction (STEMI) Management in the Era of COVID-19: A Systematic and Critical Review of Published Guidance Reports

## TL;DR

This paper reviews guidelines for managing heart attacks during the COVID-19 pandemic, highlighting differences in recommended treatments between international and Asian national guidelines.

## Contribution

The study systematically reviews and compares STEMI management guidance from global and Asian sources during the early pandemic phase.

## Key findings

- International guidelines recommend PCI as the preferred reperfusion method for STEMI.
- Three Asian national guidelines suggest fibrinolysis as the preferred method for STEMI in suspected/confirmed COVID-19 patients.
- All guidelines emphasize the importance of early COVID-19 testing for STEMI patients.

## Abstract

Coronavirus disease 2019 (COVID-19) had a major impact on
healthcare systems worldwide. During the early phase of the pandemic many
elective procedures were postponed. At the same time, the safe and effective
management of medical emergencies such as ST-segment elevation myocardial
infarction (STEMI) has been a challenge.

A systematic
literature search was conducted aiming to identify published guidance reports by
national or international societies regarding the management of patients
suffering STEMI in the era of COVID-19.

Among 1681 articles
initially retrieved, six fulfilled the inclusion criteria and were included in
the systematic review. Two reports were international consensus documents, while
four reports were national guidance statements from Asian countries (Taiwan,
India, Iran, and China). Most documents were drafted during the early phase of
the pandemic. According to the international consensus documents, percutaneous
coronary intervention (PCI) should be regarded as the reperfusion method of
choice. On the other hand, in three out of four national consensus statements
(Taiwan, Iran and China) fibrinolysis was considered as the reperfusion method of
choice for STEMI in suspected/confirmed patients with COVID-19, unless
contraindicated or in the presence of high cardiovascular risk clinical features.
Authors of all documents underlined the need for early COVID-19 testing in
patients with STEMI to better determine the next therapeutical steps.

National and international consensus statements for STEMI
management in the era of COVID-19 have been published mainly during the early
peak phase of the pandemic. Authors recognise that these recommendations are
mainly based on expert opinions and observational data. As global immunization
rates increase and methods for rapid COVID-19 detection are widely available, the
implementation of traditional evidence-based practices used before the pandemic
is becoming more feasible.