ABC | Volume 114, Nº6, June 2020

Viewpoint Guimarães et al. Acute coronary syndromes in the Covid era Arq Bras Cardiol. 2020; 114(6):1067-1071 acute ST-elevation myocardial infarction, enabling the rapid activation of catheterization laboratories and selection of the best myocardial reperfusion strategy using an individualized approach. It is possible to refer the patient directly to the heart attack center or catheterization laboratory, by-passing emergency departments, reducing hospitalization time and myocardial sequelae. 16,17 Therefore, early training of cardiology teams with pathways that include the use of telemedicine is essential for the successful implementation of such tools. Management of ACS (protocols of care) The COVID-19 pandemic has impacted the management of acute coronary syndromes, 18 particularly the speed at which proven medical and interventional therapies can be implemented. 19 For instance, in STEMI cases, reperfusion is known to be most beneficial if implemented within the first few hours of symptom onset. 20 With early actions, there is a reduction of ventricular arrhythmias, reduced myocardial damage, lower incidences of reinfarction and greater preservation of ventricular function. 21 Unfortunately, late presentations of ACS have been reported worldwide. In New York, United States, there has been a reduction of up to 70% in the volume of emergency calls due to ACS and an increase of up to 800% in sudden deaths. 22,23 Recommendations from several Medical Societies 19,20 highlight the cardiovascular clinical implications of coronavirus and call for attention to be paid to individual and populational risks. 20,21 In addition to public health strategies to prevent the spread of infection, such as influenza and pneumococcal vaccination, there is a warning of a very likely underreporting and lack of assistance for cases of acute myocardial infarction during the COVID-19 pandemic. 21,22 In this context, the creation of routes and flows aimed at the care of these patients need extensive structuring and dissemination. Figures 1 and 2 Figure 1 – Acute ST elevation myocardial infarction in the COVID era. 1068