COVID-19 and STEMI: A snapshot analysis of presentation patterns during a pandemic

The coronavirus disease 2019 (COVID-19) pandemic has emerged as a major global public health emergency [1]. Many countries, including the Republic of Ireland, have instituted restrictions on their citizens in order to reduce the transmission of the virus [2,3], colloquially referred to as ‘lockdown’. Concern has been raised regarding an observed decrease in the number of ST elevation myocardial infarction (STEMI) presentations during this period [4,5]. Numerous theories have been proposed regarding this phenomenon [4]. The most concerning hypothesis is that patients with symptoms of acute myocardial ischemia may not be presenting to medical attention due to lockdown measures or concern regarding COVID-19.</p

Performing diagnostic radial access coronary angiography on uninterrupted direct oral anticoagulant therapy: a prospective analysis

Purpose We sought to assess the safety of performing diagnostic radial access coronary angiography with uninterrupted anticoagulation on patients receiving direct oral anticoagulant therapy. Background Direct oral anticoagulants have become a popular choice for the prevention of thromboembolism. Risk factors for thromboembolism are common among cardiovascular conditions and indications for direct oral anticoagulant therapy as well as coronary angiography often overlap in patients. It has been hypothesised that uninterrupted direct oral anticoagulant therapy would increase haemorrhagic and access site complications, however data in this area is limited. Methods This was a prospective observational analysis of 49 patients undergoing elective diagnostic coronary angiography while receiving uninterrupted anticoagulation with direct oral anticoagulants. This population was compared with a control group of 49 unselected patients presenting to the cardiology service for elective diagnostic coronary angiography. Continuous variables were analysed using the independent samples t-test and categorical variables using Pearson’s χ2 test. Results The mean duration of radial compression for the control group was 235.8±62.8min and for the uninterrupted direct oral anticoagulant group was 258.4±56.5min. There was no significant difference in mean duration of radial compression (p=0.07; 95% CI=-1.4 to 46.5). There was also no difference in the complication rate between the two groups (p=1). Conclusions We observed similar complication rates and radial artery compression time postangiography in both groups. This small prospective observational study suggests that uninterrupted continuation of direct oral anticoagulants during coronary angiography is safe. Larger randomised control studies in this area would be beneficial</p