The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

EAPCI Position Statement on Invasive Management of Acute Coronary Syndromes during the COVID-19 pandemic

EuroIntervention 2020;16-online publish-ahead-of-print May 2020. DOI: 10.4244/EIJY20M05_01

1. Interventional Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy; 2. Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy; 3. Royal Brompton Hospital, London, UK; 4. Department of Advanced Biomedical Sciences University Federico II, Naples, Italy; 5. Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy; 6. European Hospital Georges Pompidou (Cardiology Department) and University of Paris, Paris, France; 7. Cardiology Department, Hospital La Paz and IDIPAZ, Madrid, Spain; 8. Department of Cardiology, North Cumbria Integrated Care NHS Foundation Trust, Cumbria, UK; 9. Service de Cardiologie, Brest University Hospital, Brest, France; 10. Department of Cardiology, Oslo University Hospital Ulleval, and University of Oslo, Oslo, Norway; 11. 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, and Sigmund Freud University, Medical School, Vienna, Austria; 12. Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Sweden; 13. Division of Cardiology and Angiology II University Heart Centre Freiburg, Bad Krozingen, Germany; 14. Department of Cardiology St.-Johannes-Hospital Klinik für Innere Medizin I, Dortmund, Germany; 15. Division of Cardiology, University Hospitals, Geneva, Switzerland; 16. Department of clinical-surgical, diagnostic and pediatric sciences, Unit of anaesthesia and intensive care, Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy; 17. Hospital Universitari Germans Trias i Pujol, Badalona, Spain; 18. Department of Cardiology, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland; 19. Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland and Maria Cecilia Hospital GVM, Cotignola, Ravenna, Italy; 20. Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, Barts Heart Centre, London, UK and Yale University School of Medicine, New Haven, CT, USA

The coronavirus disease 2019 (COVID-19) pandemic poses an unprecedented challenge to healthcare worldwide. The infection can be life threatening and require intensive care treatment. The transmission of the disease poses a risk to both patients and healthcare workers. The number of patients requiring hospital admission and intensive care may overwhelm health systems and negatively affect standard care for patients presenting with conditions needing emergency interventions. This position statements aims to assist cardiologists in the invasive management of acute coronary syndrome (ACS) patients in the context of the COVID-19 pandemic. To that end, we assembled a panel of interventional cardiologists and acute cardiac care specialists appointed by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and from the Acute Cardiovascular Care Association (ACVC) and included the experience from the first and worst affected areas in Europe. Modified diagnostic and treatment algorithms are proposed to adapt evidence-based protocols for this unprecedented challenge. Various clinical scenarios, as well as management algorithms for patients with a diagnosed or suspected COVID-19 infection, presenting with ST- and non-ST-segment elevation ACS are described. In addition, we address the need for re-organization of ACS networks, with redistribution of hub and spoke hospitals, as well as for in-hospital reorganization of emergency rooms and cardiac units, with examples coming from multiple European countries. Furthermore, we provide a guidance to reorganization of catheterization laboratories and, importantly, measures for protection of healthcare providers involved with invasive procedures.

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