STEMI Management Update 2021: What Have We Learned?

Amidst these remarkable, disruptive times, it seems appropriate that one may reasonably take some latitude in defining the length of a year. The extraordinary evolution in our care of ST-elevation myocardial infarction (STEMI) patients has been dominated by an unprecedented pandemic that has transformed the landscape of STEMI management.1 The emergence of COVID-19 as a global threat overwhelmed emergency medical services (EMS), health care systems and health care providers worldwide: remarkably, this continues to the present day. The subsequent demand for urgent medical attention, coupled with requirements for mechanical ventilation and intensive care unit beds has transformed percutaneous coronary intervention (PCI) capable hospitals into coronavirus centers, thereby attenuating PCI services with redeployment of essential providers to COVID-19 care areas. Suspensions of pre-hospital PCI lab activations to facilitate COVID testing and appropriate triage have delayed EMS response times. Impediments to inter-hospital transfers have resulted in longer total ischemic times. Paradoxically, there has been a dramatic decrease in the number of STEMI presentations related, in part, to patient concerns about exposure to COVID-19. The sometimes-confusing clinical milieu in this environment highlights the need to recognize STEMI mimics to guide appropriate therapy and avoid unnecessary angiography.