COVID-19 Patients May Present False Signal of Obstructive Coronary Artery Disease

The results of numerous studies have indicated that people with cardiovascular disease are at a greater risk of mortality with coronavirus disease 2019 (COVID-19). Yet, there have been reports of patients with COVID-19 having ST-segment elevation (STE), which is a signal of obstructive coronary artery disease. Even after invasive coronary angiography, these reports show that these patients continue to show no sign of the disease.

An article, published in Mayo Clinic Proceedings on April 9 and written by a team cardiologists and radiologists at the Mayo Clinic, explained that these false signals of coronary artery disease may be causing patients with COVID-19 to undergo procedures that present unnecessary risks to their health.

“The impact of false activation of the catheterization laboratory includes inherent risks, beginning with the invasive arterial procedure itself and related care for these patients,” said J. Wells Askew, M.D., a Mayo Clinic cardiologist, in a press release.

Askew explained that in cases where in which patients test positive for COVID-19, such risks may include respiratory failure, potential exposure of medical staff to COVID-19, and downstream effects on cardiac catheterization laboratories and cardiac imaging services.

“Nonetheless, it's critically important for patients who are experiencing a heart attack due to coronary occlusion to receive immediate and appropriate treatment,” Askew said. “There is an urgent need for an algorithm that guides triage of patients with suspected or proven COVID-19 and patients with STE to determine initial invasive or noninvasive pathways.”

The authors noted that acute myocardial injury, arrhythmia, and shock are common in patients with acute respiratory infections like such as COVID-19. Myocardial injury, defined by an elevated cardiac troponin level, when acute in the setting of acute myocardial ischemia, can also signal a heart attack, according to the study.

In the article, the authors proposed algorithms based on expert consensus that can be used when evaluating patients and determining an appropriate course of treatment. The authors also provided guidance on how to decide upon the use of an echocardiogram or a coronary CT angiogram for patients with suspected or confirmed COVID-19.

“The reported experiences from countries in which significant exposure to COVID-19 has occurred highlights the challenges we have in treating patients with COVID-19 and STE on the electrocardiogram,” Dr. Askew said in the press release. “Health care facilities need to rapidly prepare for this, so they can appropriately triage these patients with invasive or noninvasive pathways. This is critically important to minimize risks for the patient as well as risk of COVID-19 exposure to medical personnel.”

REFERENCES

• Bennett CE, Anavekar NS, Gulati R, et al. ST-segment Elevation, Myocardial Injury, and Suspected or Confirmed COVID-19 Patients: Diagnostic and Treatment Uncertainties. Mayo Clinic Proceedings. 2020. doi: 10.1016/j.mayocp.2020.04.005.
• Guidance on treating COVID-19 patients with signs of acute heart attack [news release]. ScienceDaily; April 9, 2020. sciencedaily.com/releases/2020/04/200409144802.htm. Accessed April 10, 2020.