<div id="preview-section-recommended-articles"> <section class="ListArticles"> <div class="" aria-hidden="false" aria-describedby="recommended-articles-header"> <div id="recommended-articles">Since December 2019 the infection of SARS-CoV-2 (COVID-19), starting from Wuhan, China, spread out all over the word. Italy was one of the most affected countries, especially in the northern, where, on February 20 the first confirmed case was detected. The Italian and Regional National Health Services instituted several protocols with hospital activity reorganization in order to face the increasing number of patients presenting to the emergency departments for COVID-19 and for the correct management of other emergency conditions such as ST-elevation myocardial infarction (STEMI) [ <button class="j-inline-reference inline-reference" data-refid="bb0005" id="refInSitubb0005">1</button> ]. The STEMI net was reorganized dividing the 55 hospital equipped with cardiac catheterization laboratories offering 24/7 service in to 13 Hub and 42 Spoke centres in order to centralize the resources. In this study we retrospectively evaluated the treatment of STEMI patients admitted to ASST Santi Paolo e Carlo Hospital in Milan, HUB center according to emergency medical system (EMS) network reorganization, during pandemic compared to a normal life conditions [ <button class="j-inline-reference inline-reference" data-refid="bb0010" id="refInSitubb0010">2</button> ]. The study was performed in accordance to the Declaration of Helsinki, all data were collected anonymously and all patients subscribe a disclosure for the use of personal data at hospitalization. The study period was defined between February 20, and April 14, 2020 and we compared clinical, procedural and outcome data of the population during the corresponding period in 2019. The diagnosis of SARS-COV-2 was performed by nasopharyngeal swab test. From a total of 56 STEMI patients we divided our population in two groups according to the revascularization period ( <i>n</i> = 21 in 2019, <i>n</i> = 35 in 2020). The reorganization of the EMS probably explains the increased number of STEMI in our hospital in 2020, despite a reduction in catheterization laboratory activations and of the overall rate of hospital admissions for ACS during pandemic observed in recent studies [ <button class="j-inline-reference inline-reference" data-refid="bb0015" id="refInSitubb0015">3</button> ]. <a ck-scroll-to="" id="hl0000356" href="https://www.clinicalkey.com/t0005" update-fn="scrollToFunc" class="ng-scope">Table 1</a> displays a detailed overview of clinical, procedural characteristic and main components of STEMI care among the two groups. Interestingly, we did not find any significant difference regarding clinical characteristics in particular for main cardiovascular risk factors, baseline laboratory measurements and STEMI type. The site of diagnosis was more often in a pre-hospital setting during 2020 (74.3% vs 19%, <i>p</i> = 0.01) probably due to the very smart reorganization of our regional EMS. Regarding the extension of coronary disease left anterior descending was the most represented in both populations but with a higher prevalence in 2019 (90.5% vs 58.8%, <i>p</i> = 0.01) balanced by a lower right coronary involvement (50% vs 19%, <i>p</i> = 0.02). No other significant differences were found in particular regarding cardiogenic shock at admission, out of hospital cardiac arrest, ejection fraction or the percentage of multivessel disease. On the other side in-hospital mortality was most represented in 2020 with 7/35 patients (20%) dead versus 2/21 (9.5%) in 2019 and respiratory impairment, reported in 6/35 (17%) patients in 2020 was absent in 2019. Interestingly, unlike results from other studies [ <button class="j-inline-reference inline-reference" data-refid="bb0020" id="refInSitubb0020">4</button> ] we did not find any difference also regarding main time components of STEMI care and in particular total ischemic time was similar between the two groups (80 ± 31 min in 2019, 85 ± 51 min in 2020, <i>p</i> = 0.65). Moreover, the focused overhaul of the system, with a 24/7 presence of the cathlab staff onsite, led to a speeding up with a significant reduction of the door-to-balloon time (46.2 ± 38.3 min vs 79.9 ± 39.3 min; <i>p</i> = 0.04). At multivariate analysis the only independent predictor for mortality in 2020 resulted respiratory complications (OR [95% CI] = 31.4 [2.06–478.6], <i>p</i> = 0.013). Of the 7 patients dead the final cause of death was the respiratory impairment in 5, cardiogenic shock was for the other 2. COVID-19 pandemic is the only logic difference between the two groups, but we did not find any significant correlation between COVID-19 infection and mortality (OR [95% CI] = 3.01 [0.45–19.2], <i>p</i> = 0.26). For 3 patients of the 7 dead COVID-19 diagnosis was confirmed at nasopharyngeal swab test. The very low negative predictive value of the swamp test [ <button class="j-inline-reference inline-reference" data-refid="bb0025" id="refInSitubb0025">5</button> ] may explain these findings. Focusing on the subpopulation of negative swamp test ( <i>n</i> = 27) we found a suggestive high prevalence (60%) of relative lymphocytopenia (defined as lymphocyte under 6.6%) even if we did not find any statistically significant difference regarding white blood cell (WBC) and lymphocyte absolute count comparing the 7 patients dead vs the rest of the population in 2020 (WBC 10653 ± 3732 vs 11,405 ± 4645 × 103/uL; <i>p</i> = 0.67, Lymphocyte 1.64 ± 0.84 vs 1.58 ± 1.36 × 103/uL; <i>p</i> = 0.87). In this population persisted a weak but positive correlation (Correlation 0.5; <i>p</i> = 0.013) between in-hospital mortality and respiratory complications, defined as the need for intubation or non-invasive ventilatory mechanical support. In the same subpopulation two patients had chest CT scan suggestive for COVID-19 and one of this two died. In conclusion, respiratory impairment in STEMI patients seems to be the crucial point to face with for cardiologist during COVID-19 era. Intensive care, additional preventive respiratory investigations and aggressive life support, independently from swab test result, should be suggested among all patients admitted for STEMI during pandemic.</div> </div> </section> </div>