Objective: To evaluate the efficacy and safety of fibrinolysis strategy in patients with acute ST-segment elevation myocardial infarction (STEMI) during the COVID-19 epidemic, and to provide reference value for optimization of fibrinolytic process on the premise of prevention and control of COVID-19 transmission, including self-protection of medical staff. Methods: The efficacy and safety of fibrinolysis were retrospectively analyzed in 7 patients with acute STEM, who hospitalized from February 29, 2020 to April 3, 2020 in the Department of Cardiology, Wuhan Union Hospital of Tongji Medical College, Huazhong University of Science and Technology. To optimize the fibrinolytic process on the premise of prevention and control of COVID-19 transmission, including self-protection of medical staff, a full-time medical team in charge of fibrinolysis under third-grade protection was established. The acute STEMI patients were treated immediately in a fixed and isolated area in emergency department before receiving green channel fibrinolysis. Blood samples for complete blood count, COVID-19 antibody test and nasopharyngeal swab samples for COVID-19 nucleic acid test were made before fibrinolysis, while the chest CT examination was accomplished after fibrinolysis. By comparing differences of time from the first electrocardiogram (ECG) to fibrinolysis before and after the improvement of fibrinolytic process, the effect of optimization of the fibrinolytic process was evaluated. Results: In the present study, seven patients with acute STEMI received fibrinolysis therapy, 6 of them achieved reperfusion and no bleeding was observed in all of the patients. Five out of the 7 patients were hospitalized after fibrinolysis, and the hospitalization days were 19.6 days on average. By following up to April 14, 2020, none of the 7 patients died. The first 2 patients were treated according to the routine medical procedure and the time from the first ECG to fibrinolysis were 201 and 106 minutes, respectively. After the optimization of the fibrinolytic process, the time from the first ECG to fibrinolysis of the last 5 patients were 42, 46, 51, 43 and 54 minutes, respectively，which was significantly shorter than that before optimization. Conclusions: During the COVID-19 epidemic, fibrinolysis in patients with acute STEMI is safe, effective and easy to implement. Therefore, it is recommended as the top priority for the patients with acute STEMI with indications for fibrinolysis. On the premise of prevention and control of COVID-19 transmission, including self-protection of medical staff, the duration of myocardial ischemia can be shortened by optimization of the fibrinolytic process.
目的： 评估在新型冠状病毒肺炎疫情防控期间急性ST段抬高型心肌梗死（STEMI）溶栓疗效及风险，在兼顾疫情防控、确保防护的条件下为急性STEMI溶栓治疗最优化提供参考。 方法： 回顾性分析2020年2月29日至4月3日在华中科技大学同济医学院附属协和医院本部确诊为急性STEMI并行溶栓治疗的7例患者，评估其溶栓疗效及风险；在保障疫情防控、确保防护的前提下优化溶栓流程，成立专职溶栓小组，启动三级防护，定人、定岗、定位，就地隔离溶栓，开放溶栓绿色通道，溶栓前送检血常规、新型冠状病毒肺炎（2019-nCoV）抗体检测、2019-nCoV核酸检测，待溶栓治疗结束后完善肺部CT；通过流程改进前后首次心电图至溶栓时间的比较来评估流程优化效果。 结果： 急性STEMI并行溶栓治疗患者共7例，6例再通，无出血并发症。溶栓后7例患者中有5例住院，平均住院天数19.6 d。随访至2020年4月14日，7例患者无1例死亡。最初的2例患者按常规医疗流程诊治，后5例患者按照优化后流程进行诊治。首次心电图至溶栓时间优化前分别为201、106 min，优化后分别为42、46、51、43、54 min，时间明显缩短。 结论： 在新型冠状病毒肺炎疫情防控期间，急性STEMI患者溶栓安全有效、简便、易行。对于具有溶栓适应证的急性STEMI建议首选溶栓治疗，在兼顾疫情防控、确保防护的前提下，优化溶栓流程可以缩短总心肌缺血时间。.
Keywords: COVID-19; Myocardial infarction; Thrombolytic therapy.