“It could just be a very weird week, but it really raises a concern that patients with cardiovascular complaints or concerns may not be presenting to medical care because they’re afraid of the hospital, they’re afraid of COVID-19.” “I’ve been a staff cardiologist for 7 years and a trainee for 6 before that, so in 12 or 13 years I’ve never spent a week in the CCU without seeing one traditional myocardial infarction,” he told TCTMD. In Boston, Jason Wasfy, MD, described a week spent as the attending cardiologist on the Massachusetts General Hospital cardiac care unit.
“We really need to see future data from institutions such as the N ational Cardiovascular Data Registry over the many months that this crisis will likely last to really understand the impacts that the virus itself, subsequent behavioral changes, and social distancing overall made in affecting STEMI care and outcomes,” Devireddy said.
He cautioned that this is just a 1-month estimate and not “reliable” data. In Atlanta, Chandan Devireddy, MD (Emory University School of Medicine, Atlanta, GA), estimates they’ve seen a drop in STEMI volume between 20% to 50%. “The feeling is definitely significantly less ACS,” he said, adding that he can’t yet break that down by STEMI versus NSTEMI. Payam Dehghani, MD, at the Prairie Vascular Research Network in Regina, Canada, says he’s part of a WhatsApp group with over 100 interventional cardiologists. “We are really feeling the absence of cases there,” he said. Even lower are the hospital-to-hospital urgent referrals for non-STEMI. “That’s unheard of in our place,” he said. More of TCTMD's coverage on our COVID-19 hub.Īt the Liverpool Heart and Chest Hospital in England, Rod Stables, MD, characterized his hospital as experiencing the “calm before the storm.” Yet during the night spent on call before speaking with TCTMD, he did three cases between 5 and 10 PM, then not a single call all night. This has been coupled with a “dramatic decrease” in ACS admissions, he added. At George Washington University Hospital in Washington, DC, Jonathan Reiner, MD, estimated they’ve had just two or three STEMI cases in the last 3 weeks they usually see three a week, with a yearly volume of 120-150 cases. The stories are eerily similar around the globe. I think people are terrified at home so they're not showing up in the emergency departments, which are totally collapsed.” The situation in Madrid is really difficult. That's for STEMIs-we haven't seen non-STEMI at all. At my hospital, we’ve seen around three or four patients in the last week while the normal number would be around three patients every day. “Our situation has become catastrophic and I can tell you that nearly 90% of beds in most hospitals in Madrid are COVID-19 patients, so I think the drop in Madrid may be close to 80%. That city has been hit much harder by COVID-19 than the rest of Spain. “But I can tell you that's much lower than we're seeing in Madrid,” he told TCTMD. In Spain, said Héctor Bueno, MD ( Hospital Universitario 12 de Octubre, Madrid), the interventional cardiology working group of the Spanish Society of Cardiology published a paper that shows a drop of 40%. “If symptoms are not too bad, they don't call the ambulance because they are afraid to go into hospital,” Reimers speculated. In the Lombardy region of Italy, said Bernhard Reimers, MD (Humanitas Research Hospital, Milan), STEMI cases are down by an estimated 70%.
From Milan to Madrid to Massachusetts, everyone is asking: as the COVID-19 pandemic drags on, where have all the STEMIs gone?