[COVID-19 and coronary artery disease: selective and collaborative use of resources during public health crisis]

The COVID-19 epidemic is one of the most demanding challenges for the public health organizations. The Lombardy region faced firstly this outbreak in Italy and recorded rapidly a saturation of intensive care and internal medicine beds. Consequently, this lack of technical and human resources, together with people mobility restriction to contain virus spreading, determined the interruption of elective surgical and interventional cardiovascular procedures. In addition, the emergency track of acute patients has been rewritten due to limited resources and viral co-infection (pre- or in-hospital). Herein, we describe two cases of acute coronary syndrome with severe coronary artery disease and an indication for coronary artery bypass grafting. The first patient, COVID-19 positive, was treated with transcatheter technique due to symptom instability and underwent temporary circulatory support without intubation. The second patient received an intra-aortic balloon pump and was then transferred, in accordance with government emergency provisions, to a hub hospital to undergo off-pump coronary artery bypass grafting and short intensive care unit stay. These two apparently similar cases were treated differently according to the moving epidemiological and organizational conditions.