On March 31, 2020, the full text of Recommendations from the Peking Union Medical College Hospital for the management of acute myocardial infarction during the COVID-19 outbreak was published online in European Heart Journal, internationally authoritative in the field of cardiology. The proposal was made by the COVID-19 & acute myocardial infarction (AMI) committee of Peking Union Medical College Hospital（PUMCH）. Professor Jing Zhicheng, Director of Cardiology Department and Professor Zhu Huadong, Director of Emergency Department are co-first authors, while Professor Zhang Shuyang, Party chief of PUMCH, is the corresponding author. The publication of the article brings the experience of PUMCH to the world.
Visionary Leadership，Advance layout
At the very beginning of the COVID-19 outbreak, Professor Zhang Shuyang was aware of the unprecedented medical challenge for the cardiologists to balance cardiovascular emergency patients and COVID-19 control. She and Professor Jing Zhicheng then published a review in the Chinese Journal of Cardiovascular Disease about this issue.
“On the one hand, COVID-19 can worsen underlying diseases and increase mortality. On the other hand, the pandemic has also brought great changes to the diagnosis and treatment of cardiovascular emergencies. Is there any real possibility to ensure a safe medical environment in parallel with effective re perfusion therapy, when there are patients with acute myocardial infarction (AMI) and suspected COVID-19 infection in the emergency room?”
Therefore, recommendations for the management of cardiovascular emergencies during the COVID-19 outbreak is urgently needed, especially after Professor Zhang Shuyang obtained deeper insights into the management of this complex condition based on her first-hand experience from working in Wuhan. Promoted by Professor Zhang, the AMI & COVID-19 committee of Peking Union Medical College Hospital was established under the leadership of the cardiology department, with 22 experts from the department of cardiology, emergency ,medical affairs, pharmacology, radiology, clinical laboratory, etc. The committee composed the Chinese version of Recommendations from the Peking Union Medical College Hospital for the management of acute myocardial infarction during the COVID-19 outbreak, based on the first-line experience nationwide.
Targeted measures and classified treatment
According to the recommendation, to ensure a safe and efficient medical environment for AMI treatment during the pandemic, coordination of hospital administrators and collaboration of multidisciplinary teams are needed.
It is recommended to propose precise treatment strategies and paths for two types of acute myocardial infarction:
- For acute ST-segment elevation myocardial infarction (STEMI), emergency intravenous thrombolysis is the first choice. Protecting the medical staff and other patients as well as being compliant with the principle “Save the heart, race against time”to the maximum.
- For AMI with non-ST-segment elevation (NSTEMI), it is necessary to evaluate the existence of COVID-19 as soon as possible. The treatment strategy should be based on the GRACE risk stratification while waiting for the results of novel coronavirus nucleic acid detection.
Management of suspected STEMI patients with potential risk of COVID-19 infection（upper) and Management of suspected unstable angina (UA)/NSTEMI patients with potential risk of COVID-19 infection(lower).
It is recommended to conduct the treatment in strictly accordance with the principle of laying equal stress on both the COVID-19 prevention and AMI management. The crystal clear process provides not only a "road map" for the effective implementation of the treatment plan, but also a practical guidance for front-line medical workers in the fight against COVID-19.
Sharing Knowledge，Controlling Pandemic
On February 10, 2020, PUMCH issued the treatment recommendations on its official website and WeChat Official account, and actively promoted it to clinical medical institutions nationwide. The recommendations played an active role in the treatment of AMI during the pandemic, and was applauded by colleagues throughout the country.
AS the COVID-19 pandemic spreads worldwide, Europe and North America have become the hardest hit areas. The management of suspected AMI patients with potential risk of COVID-19 infection has inevitably been a glaring problem in clinical practice. To meet this requirement, European Heart Journal, the leading international journal of cardiology as well as the official journal of the European Society of Cardiology, sent an invitation to Professor Zhang Shuyang in late March to write a clinical guideline to share the experience of PUMCH with global peers.
Based on the original Chinese version, the COVID-19 & AMI committee of Peking Union Medical College Hospital timely updated the recommendations and translated it into English. The full text was published online in European Heart Journal on March 31, 2020. It was the first time that “Peking Union Medical College Hospital” appeared in the headline of the official journal of the European Heart Association. Meanwhile, the journal also published a family portrait of the Cardiology Department group of PUMCH within nearly a full page, which shows that the experience of PUMCH has been greatly recognized by the international medical community.
Family portrait of the Cardiology Department group of PUMCH in European Heart Journal.
Virus knows no national borders, and the epidemic distinguishes no races. Only with solidarity and by cooperation can the international community prevail for the final victory. Peking Union Medical College Hospital are actively sharing unreserved knowledge of COVID-19 on the voice of China on the world stage internationally to safeguard the common homeland of humanity.
Writer: Yue Cui, Jie-Ling Ma, Hui Wang
Photo: Cardiology Department, PUMCH