COVID-19 and the management of ST-segment elevation myocardial infarction (STEMI): Adaptations to provincial standards

INESSS’s position (April 21, 2012)

Based on the scientific literature available at the time of writing and on the consultations conducted, INESSS is of the opinion that the management of ST-segment elevation myocardial infarction (STEMI) in the setting of a SARS-CoV-19 pandemic must be based on the following principles:

• Ensure the protection of the patient (and other patients in the vicinity) from SARS-CoV-2 infection;
• Ensure the protection of health care personnel who are trained in the appropriate use of personal protective equipment;
• Promote clinical activities identified as priorities and communication between partners in care networks, with the aims to preserve hospital resources and maintain quality of care;
• Maintain the overall organization of services for the management of STEMI, despite the public health emergency related to COVID-19, as well as monitoring of processes and treatment times during the pandemic.

In addition, the following are to be integrated into the provincial standards for STEMI:

• 3 additional standards for prehospital emergency services;
• 2 additional standards for hospitals that do not provide percutaneous coronary intervention (PCI);
• 3 additional standards and one modified standard for hospitals that offer PCI;
• 5 additional standards for networks; and
• 1 additional standard for support of quality improvement.

The additional standards primarily address reducing the risk of SARS-CoV-2 infection, limiting the number of providers involved in patient care and assessing and communicating infection risk. One of the additional standards expands performance monitoring to assessing the impact of COVID-19 on treatment delays.

The single modified standard adds a brief stop in the emergency department for suspected STEMI patients who have been transported to a PCI hospital by ambulance, prior to going to the catheterization laboratory.

It is emphasized that for suspected STEMI patients managed by prehospital emergency medical services, the preference for reperfusion treatment by primary PCI following direct transport to a PCI centre remains the provincial standard, regardless of the patient’s known or suspected COVID-19 status. An exception to this should be made only in the situation of complete incapacity to provide hemodynamic services.