As of April 15, 2020, the number of confirmed coronavirus disease-2019 (COVID-19) cases in New York City (NYC) was >110,000, thus making it the global epicenter of the pandemic (1). This rapid surge in the number of cases imposed a major burden on all hospitals in NYC, as well as causing significant stress in emergency departments (EDs). In addition, public health messages promoting social distancing and news reports focusing on the death toll associated with COVID-19 have created a sense of generalized anxiety in society. Changes in the observed incidence of acute cardiovascular conditions have been anecdotally reported, including the occurrence of ST-segment elevation myocardial infarctions (2). Incidentally, the number of at-home deaths in NYC has reached an 8- to 10-fold increase compared with the same time period in 2019, thereby raising concerns about the impact of the pandemic on non–COVID-related health conditions.
Acute type A aortic dissection is a life-threatening condition for which the only effective treatment requires surgical intervention, and the portal to initial diagnosis is invariably the ED. In the absence of emergency surgical intervention, 30-day mortality after acute type A aortic dissection ranges from 50% to 60% (2). The COVID-19 crisis has created additional challenges in EDs, such as more layers of screening through pre-ED triage and registration, reduced individual patient attention, rationing of timely computed tomography scanning, and confusion of atypical symptoms of type A aortic dissection with common COVID-19 presentations.
- David H.Adams, MD
Propensity-Matched Comparison of the Ross Procedure and Prosthetic Aortic Valve Replacement in AdultsIsmail El-Hamamsy, MD, PhD, Nana Toyoda, MD, PhD, Shinobu Itagaki, MD, MSc, Paul Stelzer, MD, Robin Varghese, MD, Elbert E. Williams, MD, Natalia Egorova, PhD, David H. Adams, MD
- Amine Mazine, Nitish K Dhingra, Michael W A Chu, Ismail El-Hamamsy, Mark D Peterson
- Dimosthenis Pandis, MD, MSc, Anelechi C. Anyanwu, MD, FRCS, David H. Adams, MD, FACC