Reperfusion of ST-Segment–Elevation Myocardial Infarction in the COVID-19 Era

We are in the midst of a generation-defining global pandemic; the scope, scale, and pace of which is unprecedented. COVID-19 (SARS-CoV-2 virus) occurs in addition to existing challenges to emergency services, like ST-elevation myocardial infarction (STEMI). Both conditions may coexist, initial presentations can overlap, and true and reliable point-of-care testing does not exist. Further, symptoms alone are unhelpful, as most screened for COVID test negative (30% can be false negative), and ~80% of COVID infections are asymptomatic. Experts dealing with the COVID-19 epidemic in China recommend fibrinolytic therapy (FT) over primary percutaneous coronary intervention (PPCI) for STEMI. In this perspective, we analyze the arguments for a FT-based strategy in patients presenting with STEMI in the COVID-19 era. Collectively, we feel that this is a reasonable consideration, as fibrinolysis may be the best compromise of prompt reperfusion for the patient with the least resource implications for the institution, buying time for a complete clinical picture to be made. In caring for our patients, we must recognize that optimal care strategies, established outside the challenges of a pandemic, may be potentially suboptimal during it.