New COVID-19 Guidelines in Relation to Acute Coronary Syndrome and Sepsis

As the amount of available information and research into COVID-19 is constantly changing, we wish to continue to provide you with updated information.  Please find recent guidelines regarding COVID-19 and how it relates to acute coronary syndrome (ACS) and sepsis below.

The Canadian Cardiovascular Society COVID-19 Rapid Response Team has recently released “COVID-19 and Cardiovascular Disease: What the Cardiac Healthcare Provider Should Know.¹ Several interesting points that may be of interest include:

• Myocardial injury defined as an elevation in troponin level is common (7-17%)
• Troponin elevations are more common in severe illness vs non-severe and are associated with worse outcomes
• Severe disease includes a subgroup of patients who reportedly develop a cytokine storm syndrome, including elevated NT-proBNP (27.5%), troponin (10%) and interleukin-6 levels
• Recent data from Seattle suggests cardiomyopathy was common (7%), however patients had a high rate of prior congestive heart failure (42%)

Additionally, a recent critical care guideline for the management of critically ill adults with COVID-19² has stated the following:

• The prognosis of patients with COVID-19 and shock has not been systematically reported. In a study of 150 patients from 2 hospitals in Wuhan, China, shock was a major reason for death in 40%, and may, at least in part, be due to fulminant myocarditis.
• Studies on risk factors associated with shock in patients with COVID-19 are lacking. The majority of those that are available report unadjusted estimates. Despite methodological limitations, these studies suggest that older age, comorbidities (especially diabetes and cardiovascular disease including hypertension), lower lymphocyte count, higher D-dimer level, and possibly cardiac injury are risk factors to consider.

Please note, all studies mentioned in this COVID-19 update were not completed using RAMP products manufactured by Response Biomedical Corp.  RAMP products have not been evaluated specifically for use with COVID-19 patients.

Please find the mentioned guidelines links below.

¹ Canadian Cardiovascular Society (2020). Guidance from the CCS COVID-19 Rapid Response Team. COVID-19 and Cardiovascular Disease: What the Cardiac Healthcare Provider Should Know. https://www.ccs.ca/images/Images_2020/COVID_and_Cardiovascular_Disease_22Mar2020.pdf

² Alhazzani, W., Møller, M. H., Arabi, Y. M., Loeb, M., Gong, M. N., Fan, E., … & Du, B. (2020). Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Medicine, 1-34 https://www.sccm.org/getattachment/Disaster/SSC-COVID19-Critical-Care-Guidelines.pdf?lang=en-US