The STEMI phenomenon during the COVID-19 pandemic: what is beneath the tip of the iceberg?

SARS-CoV-2, the causative agent of COVID-19, is associated with substantial cardiovascular risk and can be accompanied by acute coronary syndromes (ACS), takotsubo syndrome, myocarditis and spontaneous coronary artery dissection.1-4 The outbreak of the COVID-19 pandemic resulted in an enormous reorganisation of healthcare facilities, limiting access to emergency treatment and reducing or even halting elective procedures. ST-segment elevation myocardial infarction (STEMI) is a critical, time-dependent emergency and prompt referral for primary percutaneous coronary intervention (PPCI) is key for optimal management. Globally, a drop of ACS cases during the COVID-19 pandemic was noticed. High-quality data were initially reported from the International Study on Acute Coronary Syndromes-ST Elevation (ISACS-STEMI) COVID-19, which is a multinational multicentre retrospective registry aiming to provide a snapshot of incidence estimates and outcomes of STEMI during the COVID-19 pandemic. In their initial report, the authors described a reduction of PPCI procedures, delays in STEMI treatment and an increased in-hospital mortality in Europe during the COVID-19 pandemic compared with a pre-pandemic period5. © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.